Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DNF000216 | GA |
NPI | 1104866466 |
---|---|
Provider Name | Dr. Michael L Myers |
First Address | Augusta, GA 30912-0004 |
Second Address | Augusta, GA 30912-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 12/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000688938A | (05) | GA |
ZG0216 | (05) | SC |