Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 047859 | GA |
NPI | 1003915158 |
---|---|
Provider Name | Dr. Michael S. Vavrik |
First Address | Carrollton, GA 30117-3922 |
Second Address | Carrollton, GA 30117-3922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |