Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 48145 | GA |
NPI | 1033217252 |
---|---|
Provider Name | James Van Eaton |
First Address | Stockbridge, GA 30281-9069 |
Second Address | Stockbridge, GA 30281-9069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 02/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H21967 | (02) | GA |