Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 036594 | GA |
NPI | 1205825205 |
---|---|
Provider Name | Gregory Doyle Perry |
First Address | Athens, GA 30606-2762 |
Second Address | Athens, GA 30606-2762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 09/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00656422A | (05) | GA |
G02936 | (02) | GA |