Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 7010 | GA |
NPI | 1053784223 |
---|---|
Provider Name | Mr. Roy Witherington SR. |
First Address | Sarasota, FL 34232-1215 |
Second Address | Augusta, GA 30901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2015 |
Last Update Date | 10/11/2015 |