Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 019205 | GA |
Y | 207RI0011X | Interventional Cardiology | 019205 | GA |
NPI | 1063406262 |
---|---|
Provider Name | Paul Lawrence Douglass |
First Address | Atlanta, GA 30303-1620 |
Second Address | Atlanta, GA 30303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 09/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00241788A | (05) | GA |
060017368/CM0845 | RAILROAD MEDICARE (01) | GA |
D29329 | (02) | GA |