Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 8424 | GA |
NPI | 1811000268 |
---|---|
Provider Name | William Paisley Hines |
First Address | Lagrange, GA 30240-4146 |
Second Address | Lagrange, GA 30240-4146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 22/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000180496A | (05) | GA |
T97650 | (02) | GA |