Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 051206 | GA |
Y | 207RP1001X | Pulmonary Disease | 051206 | GA |
NPI | 1053385930 |
---|---|
Provider Name | Jose Fernando Aristizabal |
First Address | Decatur, GA 30033-6149 |
Second Address | Decatur, GA 30033-6149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 25/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053385930 | NPI (01) | GA |
G60313 | (02) |