Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 053718 | GA |
NPI | 1013936178 |
---|---|
Provider Name | Kirk D Saddler |
First Address | Snellville, GA 30078 |
Second Address | Snellville, GA 30078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H34039 | (02) |