Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 049787 | GA |
NPI | 1235237546 |
---|---|
Provider Name | Jay B Bender |
First Address | Roswell, GA 30076-4907 |
Second Address | Roswell, GA 30076-4907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 27/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
049787 | LICENSE (01) | GA |
H42962 | (02) | GA |