Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 083494 | GA |
NPI | 1093086159 |
---|---|
Provider Name | Patrick K Alfred |
First Address | Fayetteville, GA 30214-1616 |
Second Address | Fayetteville, GA 30214-1616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2012 |
Last Update Date | 21/01/2012 |