NPI age
19 years
Enumerated 2006-12-13
Across 1678 active psychiatry & neurology providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 202I265776 | MEDICARE PTAN |
| 01 (DE) | C10007335 | LIC # |
| 05 (GA) | 003101082A |
Part of a multi-provider practice. 10 other active providers share this practice address in NPPES.
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