Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CHIR006422 | GA |
NPI | 1407983885 |
---|---|
Provider Name | Dr. Mitchell Shea Arnold |
First Address | Marietta, GA 30064-1072 |
Second Address | Marietta, GA 30064-1072 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 12/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U99912 | (02) | GA |