Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD060715 | GA |
NPI | 1063652212 |
---|---|
Provider Name | Dr. Ryan Noelle Fogg |
First Address | Gainesville, GA 30501-3862 |
Second Address | Gainesville, GA 30501-3862 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2009 |
Last Update Date | 10/01/2018 |