Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CHIRO04999 | GA |
NPI | 1295819209 |
---|---|
Provider Name | Dr. Perry Philemon Little JR. |
First Address | Stone Mountain, GA 30083-3441 |
Second Address | Stone Mountain, GA 30083-3441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00810213A | (05) | GA |
U71981 | (02) | GA |