Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DN006391 | GA |
NPI | 1245267749 |
---|---|
Provider Name | Joel Martin Adler |
First Address | Atlanta, GA 30327 |
Second Address | Atlanta, GA 30327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00044096A | (05) | GA |
T-86427 | (02) | GA |