Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 11592 | GA |
NPI | 1063568996 |
---|---|
Provider Name | Dr. Warren Rivera-Morales |
First Address | Newnan, GA 30265-1339 |
Second Address | Newnan, GA 30265-1339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 08/07/2007 |