Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 69331 | GA |
NPI | 1700042132 |
---|---|
Provider Name | Preston Leigh Imhof |
First Address | Atlanta, GA 30324-6025 |
Second Address | Decatur, GA 30033-6131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2008 |
Last Update Date | 23/03/2016 |