Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 82608 | GA |
N | 207RP1001X | Pulmonary Disease | 82608 | GA |
NPI | 1053653089 |
---|---|
Provider Name | Gabriel Thornton |
First Address | Augusta, GA 30909-6512 |
Second Address | Augusta, GA 30909-6521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2013 |
Last Update Date | 10/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003218677B | (05) | GA |
GPB283 | (05) | SC |