Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 55904 | GA |
Y | 207RP1001X | Pulmonary Disease | 055904 | GA |
NPI | 1043375025 |
---|---|
Provider Name | Joseph Eugene West |
First Address | Gainesville, GA 30501-3862 |
Second Address | Gainesville, GA 30501-3862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 14/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
398169319A | (05) | GA |
I31315 | (02) |