Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 030548 | GA |
NPI | 1013081652 |
---|---|
Provider Name | Guy H Sommers JR. |
First Address | Smyrna, GA 30060 |
Second Address | Smyrna, GA 30060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00630781B | (05) | GA |
D30861 | (02) |