Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 047443 | GA |
NPI | 1093776056 |
---|---|
Provider Name | Jeffrey F Hines |
First Address | Austell, GA 30106-6810 |
Second Address | Austell, GA 30106-6810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 20/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000882714K | (05) | GA |