Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 18697 | GA |
NPI | 1285725887 |
---|---|
Provider Name | Mr. Daniel E Mcbrayer |
First Address | Bremen, GA 30110 |
Second Address | Bremen, GA 30110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 05/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G036870281 | PTAN (01) |