NPI age
18 years
Enumerated 2007-07-16
Across 4616 active physician assistant providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 1077177 | NCCPA |
| 05 (GA) | 407631325B | |
| 01 (GA) | 005117 | GEORGIA MEDICAL LICENSE |
| 05 (GA) | 407631325A |
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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