Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 065799 | GA |
Y | 2086S0105X | Surgery of the Hand | 065799 | GA |
NPI | 1154535797 |
---|---|
Provider Name | Trevor Tyrone Starnes |
First Address | Marietta, GA 30060-9403 |
Second Address | Marietta, GA 30060-9403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 27/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202I204782 | MEDICARE PTAN (01) | GA |