NPI age
19 years
Enumerated 2007-03-15
Across 117 active point of service providers in Georgia.
6 individual providers on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 604196354B | SOURCE |
| 01 (GA) | 604196354A | CCSP |
| 01 (GA) | 604196354D | COMP |
| 01 (GA) | 604196354C | NOW WAIVER |
Multi-provider organization. 6 individual providers on file at this primary address.
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