Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CHIRO02073 | GA |
NPI | 1790991149 |
---|---|
Provider Name | Larry Roy Zezula |
First Address | Marietta, GA 30062 |
Second Address | Marietta, GA 30062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/07/2007 |