Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 046072 | GA |
Y | 208600000X | Surgeon | 046072 | GA |
NPI | 1023081437 |
---|---|
Provider Name | Vincent S Culpepper |
First Address | Cordele, GA 31015-3208 |
Second Address | Cordele, GA 31015-3753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 25/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000978667A | (05) | GA |
000978667B | (05) | GA |
000978667C | (05) | GA |
H78353 | (02) |