Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 17801 | GA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 17801 | GA |
NPI | 1164473229 |
---|---|
Provider Name | Mr. Robert P Frady |
First Address | Dalton, GA 30720-2637 |
Second Address | Dalton, GA 30720-2637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D29499 | (02) |