Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 885 | GA |
NPI | 1457375362 |
---|---|
Provider Name | Dr. William Page Nolan |
First Address | Augusta, GA 30904 |
Second Address | Augusta, GA 30904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |