Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 026486 | GA |
NPI | 1114967031 |
---|---|
Provider Name | Wilfred Q Cole III |
First Address | Kennesaw, GA 30144-3715 |
Second Address | Alpharetta, GA 30004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 11/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00292102E | (05) | GA |
A37381 | (02) |