Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 4643 | TN |
NPI | 1073507604 |
---|---|
Provider Name | Dr. Michael A Skinner |
First Address | Brentwood, TN 37027-3291 |
Second Address | Brentwood, TN 37027-3291 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 08/07/2007 |