NPI age
20 years
Enumerated 2005-08-10
Across 643 active internal medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 | 10BBBMT | MEDICARE PTAN (INDIVIDUAL) |
| 05 (GA) | 00463009E | |
| 01 (GA) | GRP 3931 | MEDICARE PTAN (GROUP) |
| 05 (GA) | 00463009B |
Part of a multi-provider practice. 10 other active providers share this practice address in NPPES.
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