Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 050244 | GA |
NPI | 1255331674 |
---|---|
Provider Name | George Kevin Perdue |
First Address | Atlanta, GA 30339-3179 |
Second Address | Stockbridge, GA 30281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 14/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000911061E | (05) | GA |
000911061F | (05) | GA |
H42587 | (02) | |
P00072861 | RAILROAD MEDICARE (01) | GA |