Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 010407 | GA |
NPI | 1083826598 |
---|---|
Provider Name | Edwin L. Lamb |
First Address | Valdosta, GA 31602-4904 |
Second Address | Valdosta, GA 31605-7416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |