Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 063296 | GA |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 63296 | GA |
NPI | 1013120930 |
---|---|
Provider Name | Shahram Bozorgnia |
First Address | Augusta, GA 30912-0004 |
Second Address | Augusta, GA 30912-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 29/05/2019 |