Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN008602 | GA |
NPI | 1578745162 |
---|---|
Provider Name | Dr. William G Bumgarner |
First Address | Douglasville, GA 30134-1756 |
Second Address | Douglasville, GA 30134-1756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2007 |
Last Update Date | 23/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000153414E | (05) | GA |
000153414F | (05) | GA |
102300 | AVESIS (01) | GA |
9208296 | DORAL (01) | GA |