Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 040090 | GA |
NPI | 1194708347 |
---|---|
Provider Name | Dr. Robert E Hancock |
First Address | Athens, GA 30606-2184 |
Second Address | Athens, GA 30606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 26/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F88621 | (02) | GA |