Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | CHIR010245 | GA |
NPI | 1063027548 |
---|---|
Provider Name | Dr. Matthew Karl, Owen Henrikson |
First Address | Woodstock, GA 30188-3166 |
Second Address | Roswell, GA 30075-2277 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2020 |
Last Update Date | 11/09/2020 |