NPI age
19 years
Enumerated 2006-06-15
Across 5448 active family medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 00949869D | |
| 01 (SC) | 27337 | LICENSE |
| 01 (GA) | 10056648 | AMERIGROUP |
Part of a multi-provider practice. 19 other active providers share this practice address in NPPES.
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