Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 039089 | GA |
NPI | 1003826942 |
---|---|
Provider Name | John J Doran |
First Address | Atlanta, GA 30322-1013 |
Second Address | Atlanta, GA 30322-1013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 15/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G98370 | (02) | GA |