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General NPI Number Information
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NPI Number | 1679108328
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Entity Type | Organization
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Legal Business Name | SECOND OPINION PHYSICIAN
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Dates
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Enumeration Date | 03/03/2020
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 133 TYE ST SE
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City | ATLANTA
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State | GA
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Zip | 30316-1140
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Country | US
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Telephone | 678-400-7768
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Fax |
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Provider Business Mailing Address
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Address Line | 133 TYE ST SE
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City | ATLANTA
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State | GA
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Zip | 30316-1140
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Country | US
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Telephone | 678-400-7768
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DAVID EPSTEIN
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Credential | D.O.
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Telephone | 678-400-7768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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