Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN014319 | GA |
NPI | 1083873640 |
---|---|
Provider Name | Dr. Michael Mchaney Demo |
First Address | Atlanta, GA 30305-3428 |
Second Address | Atlanta, GA 30305-3428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2008 |
Last Update Date | 15/11/2016 |