NPI age
16 years
Enumerated 2009-10-06
Across 1280 active radiology providers in Georgia.
10 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 003125154A | |
| 01 (GA) | 2021300321 | MEDICARE/PTAN |
| 01 (GA) | 003125154A | GEORGIA MEDICAID/PEACHCARE FOR KIDS PROGRAM |
Solo or small practice. No other active providers share this practice address in NPPES.
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