Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN010545 | GA |
NPI | 1417548827 |
---|---|
Provider Name | Stanley Chris Gay |
First Address | Dublin, GA 31021-3281 |
Second Address | Hardwick, GA 31034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2021 |
Last Update Date | 28/01/2021 |