Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 9387 | GA |
Y | 213EG0000X | General Practice | 9387 | GA |
NPI | 1003909243 |
---|---|
Provider Name | Dr. Joseph T. Sumrall JR. |
First Address | Bonaire, GA 31005-3907 |
Second Address | Warner Robins, GA 31088-3904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |