Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 1004 | GA |
NPI | 1083783047 |
---|---|
Provider Name | Dr. John Edward Farrar |
First Address | Hilton Head Island, SC 29928-5502 |
Second Address | Fort Stewart, GA 31314-5674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 17/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000415324A | (05) | GA |