NPI age
20 years
Enumerated 2006-02-13
Across 30 active pathology providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 003140616 | |
| 01 (GA) | 056878 | GEORGIA LICENSE |
| 05 (FL) | 003007800 | |
| 01 (FL) | 149H6 | BLUE CROSS BLUE SHIELD |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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