NPI age
20 years
Enumerated 2006-05-10
Across 640 active physician assistant providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 001143 | STATE LICENSE |
| 05 (AL) | 156095 | |
| 05 (GA) | 003142832B | |
| 01 (GA) | 20297I0265 | MEDICARE PTAN |
Part of a multi-provider practice. 95 other active providers share this practice address in NPPES.
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