Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 024049 | LA |
Y | 207X00000X | Orthopaedic Surgeon | 75377 | GA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 75377 | GA |
NPI | 1013013101 |
---|---|
Provider Name | Mr. Jonathan Michael Shults |
First Address | Savannah, GA 31406-2507 |
Second Address | Savannah, GA 31406-2507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 12/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1422649 | (05) | LA |
202I204118 | (02) | GA |
H64715 | (02) | LA |