Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 051054 | GA |
N | 2081P2900X | Pain Medicine | 051054 | GA |
NPI | 1083775670 |
---|---|
Provider Name | Sackdinanh Nok Keomahathai |
First Address | Atlanta, GA 30326-2822 |
Second Address | Dallas, GA 30157-1622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 28/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000937153A | (05) | GA |
H27211 | (02) |