Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 005498 | GA |
NPI | 1629254115 |
---|---|
Provider Name | Dr. Mark Allan Amos |
First Address | Woodstock, GA 30188-3094 |
Second Address | Woodstock, GA 30188-3094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2008 |
Last Update Date | 14/01/2008 |