Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | PT000649 | GA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT000649 | GA |
NPI | 1811930506 |
---|---|
Provider Name | Mr. Donald Showalter |
First Address | Conyers, GA 30013-6384 |
Second Address | Conyers, GA 30013-6384 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 02/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000975477A | (05) | GA |
00975477B | (05) | GA |
650023207 | RAIL ROAD (01) | GA |