Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 33468 | SC |
N | 111NI0900X | Internist | 33468 | SC |
N | 207RC0000X | Internist - Cardiovascular Disease | 33468 | SC |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 33468 | SC |
NPI | 1083948285 |
---|---|
Provider Name | Dr. Walter Robert Mazzei JR. |
First Address | Atlanta, GA 30374-3904 |
Second Address | Columbia, SC 29203-8005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2009 |
Last Update Date | 02/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
334686 | (05) | SC |