Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 73081 | GA |
NPI | 1386041903 |
---|---|
Provider Name | Imre Bodo |
First Address | Atlanta, GA 30342-1764 |
Second Address | Atlanta, GA 30342-1764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2014 |
Last Update Date | 25/11/2014 |