Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 16176 | SC |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 67757 | GA |
NPI | 1003820259 |
---|---|
Provider Name | Dr. Michael Douglas Hellstrom |
First Address | Atlanta, GA 30305-1717 |
Second Address | Atlanta, GA 30328-3473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 07/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TL2139 | (05) | SC |