NPI age
20 years
Enumerated 2005-11-04
Across 399 active specialist/technologist, other providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 1264 | NSAA |
| 01 (KY) | SA193 | KENTUCKY BOARD OF MEDICAL LICENSURE |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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