Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 028997 | GA |
N | 207Q00000X | Family Doctor | 058279 | MA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 028997 | GA |
NPI | 1568412146 |
---|---|
Provider Name | Perry R Hearn |
First Address | Watkinsville, GA 30677-0015 |
Second Address | Athens, GA 30606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 26/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3025161 | (05) | MA |
B98047 | (02) |