Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 37674 | GA |
NPI | 1104872084 |
---|---|
Provider Name | Dr. Kevin L Schaffer |
First Address | Sandy Springs, GA 30350-4115 |
Second Address | Snellville, GA 30078-5643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 12/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00057237C | (05) | GA |
F15878 | (02) | GA |