Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 033303 | GA |
NPI | 1063440238 |
---|---|
Provider Name | John Devn Cornish |
First Address | Atlanta, GA 30322-0001 |
Second Address | Atlanta, GA 30322-0001 |
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 |
---|---|---|
00437489G | (05) | GA |
C35263 | (02) |