Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 64416 | GA |
Y | 208600000X | Surgeon | 64416 | GA |
NPI | 1013196492 |
---|---|
Provider Name | Dr. Vanchad C Memark |
First Address | Hiram, GA 30141-3754 |
Second Address | Hiram, GA 30141-3754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2007 |
Last Update Date | 30/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2949877 | (05) | OH |