Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 75990 | GA |
NPI | 1033382122 |
---|---|
Provider Name | Michael Richard Corey |
First Address | Woodstock, GA 30189-4881 |
Second Address | Marietta, GA 30060-1176 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2008 |
Last Update Date | 22/04/2020 |