Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 01021167 | GA |
Y | 208800000X | Urologist | 21167 | GA |
NPI | 1063419281 |
---|---|
Provider Name | Mr. William Bird Jones |
First Address | Gainesville, GA 30501-2075 |
Second Address | Gainesville, GA 30501-2075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 15/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00190638A | (05) | GA |
260960438C | MEDICARE (01) | GA |
D70479 | (02) | GA |