NPI age
15 years
Enumerated 2010-07-04
Across 152 active clinic/center providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 003111721A | |
| 01 (GA) | 202G709590 | MEDICARE PTAN |
| 01 (GA) | 704857 | WELLCARE |
Doing-business-as, former, and alternate names recorded by NPPES.
Single-site organization. Only one practice location on file.
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