Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 18773 | GA |
NPI | 1023169208 |
---|---|
Provider Name | Raymon Joel Wilensky |
First Address | Atlanta, GA 30305 |
Second Address | Kennesaw, GA 30144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 16/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000144185B | (05) | GA |
C53046 | (02) |