Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 039623 | GA |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 039623 | GA |
NPI | 1821105073 |
---|---|
Provider Name | Dr. Michael J Litrel |
First Address | Canton, GA 30114 |
Second Address | Canton, GA 30114-5256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 30/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000743366J | (05) | GA |
000743366K | (05) | GA |
00743366I | (05) | GA |
16BBBPP | MEDICARE (01) | GA |
G52999 | (02) |