Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 036137 | GA |
Y | 2080P0201X | Pediatric Allergist | 036137 | GA |
NPI | 1649274630 |
---|---|
Provider Name | Dr. William Kennedy Dolen |
First Address | Augusta, GA 30901-2602 |
Second Address | Augusta, GA 30912-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 18/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000515996A | (05) | GA |
G08300 | (05) | SC |