Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 44757 | GA |
NPI | 1003891300 |
---|---|
Provider Name | Dr. William Paul Ives |
First Address | Lawrenceville, GA 30045-3469 |
Second Address | Snellville, GA 30078-6460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 23/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G33643 | (02) |