Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 054617 | GA |
NPI | 1376755538 |
---|---|
Provider Name | Paul L Mefferd |
First Address | Marietta, GA 30060-7282 |
Second Address | Marietta, GA 30060-7282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 17/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003141012A | (05) | GA |
1710946322 | GROUP NPI (01) | GA |