Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | CHIR006978 | GA |
NPI | 1851554125 |
---|---|
Provider Name | Duane Ollie Fields |
First Address | Bonaire, GA 31005-3826 |
Second Address | Bonaire, GA 31005-3826 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 08/07/2008 |