Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 034610 | GA |
NPI | 1326135591 |
---|---|
Provider Name | Dr. Kurt Frederick Heiss |
First Address | Stone Mountain, GA 30087-1826 |
Second Address | Atlanta, GA 30345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B49035 | (02) | GA |