Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 11365 | GA |
NPI | 1215184338 |
---|---|
Provider Name | Mr. Warren Gary Berne |
First Address | Woodstock, GA 30188-3705 |
Second Address | Woodstock, GA 30188-3705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2008 |
Last Update Date | 20/08/2008 |