Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | L2684 | TX |
Y | 208600000X | Surgeon | L2684 | TX |
NPI | 1013097351 |
---|---|
Provider Name | John Sweeney |
First Address | Atlanta, GA 30322-1059 |
Second Address | Atlanta, GA 30322-1013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 06/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3181269 | (05) | TX |
G14290 | (02) |