Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 59366 | GA |
NPI | 1841405875 |
---|---|
Provider Name | Jed Axelrod |
First Address | Atlanta, GA 30342-4767 |
Second Address | Atlanta, GA 30342-4767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2007 |
Last Update Date | 25/06/2021 |