Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 073476 | GA |
Y | 207RA0401X | Internist - Addiction Medicine | 307566 | LA |
NPI | 1013952852 |
---|---|
Provider Name | Dr. William Robert Rout |
First Address | Augusta, GA 30906 |
Second Address | Augusta, GA 30906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 03/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
069706100 | (05) | FL |
D57873 | (02) |