Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 028807 | GA |
NPI | 1053432401 |
---|---|
Provider Name | Mr. Marc Joel Kornfield |
First Address | Marietta, GA 30066-6053 |
Second Address | Marietta, GA 30066-6053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |