Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 1415 | GA |
NPI | 1255397147 |
---|---|
Provider Name | Mr. Jeffery Dean Parson |
First Address | Tifton, GA 31794-3640 |
Second Address | Tifton, GA 31794-3640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 27/11/2007 |