Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 14856 | GA |
NPI | 1003215948 |
---|---|
Provider Name | Samuel Posey |
First Address | Locust Grove, GA 30248-4125 |
Second Address | Locust Grove, GA 30248-4125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2014 |
Last Update Date | 14/01/2015 |