Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 018954 | GA |
NPI | 1023085081 |
---|---|
Provider Name | Y Khalid Siddiq |
First Address | Austell, GA 30106-6810 |
Second Address | Austell, GA 30106-6810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 28/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00152655A | (05) | GA |
D30828 | (02) | GA |