Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 14507 | GA |
NPI | 1295737328 |
---|---|
Provider Name | Melvin Lee Haysman |
First Address | Savannah, GA 31404-6234 |
Second Address | Savannah, GA 31404-6234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 01/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00114078A | (05) | GA |
D29712 | (02) |