NPI age
20 years
Enumerated 2006-05-19
Across 1389 active surgery providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (WV) | BR5113081 | MEDICARE PART B GROUP |
| 01 (WV) | 0001417002 | MEDICAID GROUP |
| 01 (WV) | 5T5100381 | MEDICARE GROUP |
| 05 (WV) | 7300262000 |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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