Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 077888 | GA |
NPI | 1003027905 |
---|---|
Provider Name | Shashikant Patil |
First Address | Atlanta, GA 30339 |
Second Address | Athens, GA 30606-2797 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 14/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07698 | (05) | LA |