Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 033881 | GA |
NPI | 1003834557 |
---|---|
Provider Name | Michael Anthony Poss |
First Address | Carrollton, GA 30117 |
Second Address | Carrollton, GA 30117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000511805E | (05) | GA |
E92200 | (02) |