Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN009718 | GA |
NPI | 1003950247 |
---|---|
Provider Name | Dr. Robert H Creager |
First Address | Conyers, GA 30094-5103 |
Second Address | Conyers, GA 30094-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 08/07/2007 |