Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 15972 | GA |
NPI | 1265695464 |
---|---|
Provider Name | Dr. Michael Frank Podobnikar JR. |
First Address | Stockbridge, GA 30281-3566 |
Second Address | Stockbridge, GA 30281-5085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 08/07/2008 |