Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 044119 | GA |
NPI | 1366553349 |
---|---|
Provider Name | Mr. Brian J Szwarc |
First Address | Thomasville, GA 31792-6678 |
Second Address | Thomasville, GA 31792-6676 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 01/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00755939B | (05) | GA |
G54575 | (02) | GA |