Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 007916 | GA |
NPI | 1194711093 |
---|---|
Provider Name | Dr. William C Tippins JR. |
First Address | Tucker, GA 30084-6929 |
Second Address | Tucker, GA 30084-6929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 11/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00091594D | (05) | GA |
D46340 | (02) | GA |