Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 050360 | GA |
NPI | 1043218001 |
---|---|
Provider Name | Dr. Michael Dwyer |
First Address | Atlanta, GA 30328-5382 |
Second Address | Atlanta, GA 30328-5382 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 17/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000932269B | (05) | GA |
000932269E | (05) | GA |
00932269A | (05) | GA |