Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 2932 | GA |
NPI | 1154424463 |
---|---|
Provider Name | Jon Khoury |
First Address | Marietta, GA 30060-1155 |
Second Address | Marietta, GA 30060-1155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 10/07/2013 |