Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 72195 | GA |
Y | 208600000X | Surgeon | 72195 | GA |
N | 2082S0105X | Plastic Hand Surgeon | 72195 | GA |
NPI | 1689876526 |
---|---|
Provider Name | Nelson Castillo |
First Address | Atlanta, GA 30342-4763 |
Second Address | Atlanta, GA 30342-4763 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 22/04/2015 |