Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 035594 | GA |
N | 2086S0122X | Plastic and Reconstructive Surgery | 035594 | GA |
NPI | 1053364166 |
---|---|
Provider Name | Harvey Penfield Cole III |
First Address | Atlanta, GA 30342 |
Second Address | Atlanta, GA 30342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 24/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000503753C | (05) | GA |
E57952 | (02) |