Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7643 | GA |
NPI | 1326207440 |
---|---|
Provider Name | Dr. Kenneth Wayne Spraggins |
First Address | Atlanta, GA 30303-3030 |
Second Address | Atlanta, GA 30303-3030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2008 |
Last Update Date | 04/06/2008 |