NPI age
19 years
Enumerated 2006-09-01
Across 5448 active family medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 000904615A | MEDICAID ID FROM OLD GROUP |
| 01 (GA) | 08BBVCP | MEDICARE PTAN FROM OLD GROUP |
| 05 (SC) | GA1017 | |
| 01 (GA) | P00778527 | RR MEDICARE |
| 05 (GA) | 296899578B |
Part of a multi-provider practice. 40 other active providers share this practice address in NPPES.
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