NPI age
19 years
Enumerated 2007-02-13
Across 5448 active family medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (MS) | 08535894 | |
| 01 (MS) | 080262879 | MS MEDICARE NO. |
| 01 (MS) | 19655 | MS STATE LICENSE # |
Part of a multi-provider practice. 89 other active providers share this practice address in NPPES.
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