Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 030659 | GA |
NPI | 1023235512 |
---|---|
Provider Name | Robert F. Parham |
First Address | Cartersville, GA 30120-3628 |
Second Address | Cartersville, GA 30120-3628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00442373B | (05) | GA |