Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 52072 | GA |
NPI | 1003800665 |
---|---|
Provider Name | Dr. Russell Gore |
First Address | Atlanta, GA 30309-1426 |
Second Address | Atlanta, GA 30322-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 31/01/2018 |