Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CHIR007904 | GA |
NPI | 1023203213 |
---|---|
Provider Name | Mr. Peter Joseph Scire |
First Address | Peachtree City, GA 30269-3538 |
Second Address | Peachtree City, GA 30269-3538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2007 |
Last Update Date | 11/09/2007 |