Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 031484 | GA |
NPI | 1104871730 |
---|---|
Provider Name | Nelson M Oyesiku |
First Address | Atlanta, GA 30322 |
Second Address | Atlanta, GA 30322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E16158 | (02) |