Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 010580 | GA |
NPI | 1023145406 |
---|---|
Provider Name | Dr. Robert Lawson Waugh JR. |
First Address | Athens, GA 30606 |
Second Address | Athens, GA 30606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 21/01/2022 |