Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 031308 | GA |
Y | 207R00000X | Internist | 031308 | GA |
Y | 111NI0900X | Internist | 031308 | GA |
N | 207RG0300X | Geriatric Medicine | 031308 | GA |
NPI | 1093758724 |
---|---|
Provider Name | George Clark Pursley |
First Address | Augusta, GA 30909-1899 |
Second Address | Augusta, GA 30909-1867 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 25/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00391399B | (05) | GA |
00391399Q | (05) | GA |
E16161 | (02) | GA |