Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1790026235 |
---|---|
Provider Name | Dr. Timothy Eugene Gates |
First Address | Dewy Rose, GA 30634-3006 |
Second Address | Dewy Rose, GA 30634-3006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2013 |
Last Update Date | 07/03/2013 |