Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA002263 | GA |
NPI | 1003962846 |
---|---|
Provider Name | Mr. Harold Hugh Herring JR. |
First Address | Toccoa, GA 30577-1633 |
Second Address | Clayton, GA 30525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00961111A | (05) | GA |