Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 052821 | GA |
Y | 2080P0202X | Pediatric Cardiologist | 052821 | GA |
NPI | 1194763789 |
---|---|
Provider Name | Henaro C Sabino JR. |
First Address | Rome, GA 30165-1369 |
Second Address | Rome, GA 30165-1416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 30/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I12253 | (02) |