Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 19588 | SC |
NPI | 1023009701 |
---|---|
Provider Name | George Timothy Baxley |
First Address | Easley, SC 29641-2089 |
Second Address | Clemson, SC 29631-1448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 29/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
195880 | (05) | SC |
H31684 | (02) | SC |