Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ME 92466 | FL |
Y | 207QS0010X | Family Doctor - Sports Medicine | 059115 | GA |
NPI | 1245291616 |
---|---|
Provider Name | John Addison Alsobrook |
First Address | Atlanta, GA 30374-2616 |
Second Address | Buford, GA 30518-5878 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 15/02/2021 |