Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 9880 | GA |
NPI | 1003181231 |
---|---|
Provider Name | William Martin |
First Address | Atlanta, GA 30327-1539 |
Second Address | Atlanta, GA 30327-1539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2012 |
Last Update Date | 21/03/2012 |