Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | P414 | SC |
NPI | 1013987247 |
---|---|
Provider Name | Mr. William H Gaw JR. |
First Address | Atlanta, GA 30374-3904 |
Second Address | Columbia, SC 29203-6859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 27/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8302499 | PHP PROVIDER (01) | |
NP0028 | (05) | SC |
S00884 | (02) | SC |
S0884 | (02) | NC |