NPI age
14 years
Enumerated 2012-02-16
Across 1389 active surgery providers in Georgia.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 077649 | MEDICAL LICENSE |
| 05 (GA) | 003190187B |
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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