Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 9994 | GA |
NPI | 1033576921 |
---|---|
Provider Name | Hal Arnold |
First Address | Atlanta, GA 30342-4538 |
Second Address | Atlanta, GA 30342-4538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2016 |
Last Update Date | 22/01/2016 |