Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 84976 | GA |
NPI | 1144752411 |
---|---|
Provider Name | Hubert Pare |
First Address | Macon, GA 31201 |
Second Address | Macon, GA 31201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2017 |
Last Update Date | 25/08/2021 |