Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 6497 | GA |
NPI | 1598719031 |
---|---|
Provider Name | Dr. Ryan Lee Overton |
First Address | Columbus, GA 31904-9091 |
Second Address | Columbus, GA 31904-9091 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 20/09/2012 |