Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 56552 | MN |
Y | 207T00000X | Neurosurgeon | 82595 | GA |
NPI | 1003179425 |
---|---|
Provider Name | Marcus J Gates |
First Address | Austell, GA 30106-8116 |
Second Address | Austell, GA 30106-8116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2012 |
Last Update Date | 02/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |