Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 16523 | GA |
NPI | 1073548095 |
---|---|
Provider Name | Mr. Richard Borden Sasnett JR. |
First Address | Evans, GA 30809-3301 |
Second Address | Evans, GA 30809-3301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 30/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00184445A2 | (05) | GA |
D30709 | (02) |