Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 044469 | GA |
NPI | 1073522827 |
---|---|
Provider Name | Dr. Kevin Gomez |
First Address | Atlanta, GA 30342-1606 |
Second Address | Atlanta, GA 30342-1606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 23/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000766257K | (05) | GA |
000766257L | (05) | GA |
000766257N | (05) | GA |
000766257O | (05) | GA |
000766257Q | (05) | GA |
186509177A | (05) | GA |
D57888 | (02) | GA |