Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO02185 | |
N | 222Z00000X | Podiatrist | CPO02185 | |
Y | 224P00000X | Prosthetist | 2 | GA |
NPI | 1336572403 |
---|---|
Provider Name | Mr. Edward Gurin |
First Address | Johns Creek, GA 30097-7859 |
Second Address | Johns Creek, GA 30097-7859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2013 |
Last Update Date | 13/08/2013 |