NPI age
19 years
Enumerated 2006-10-18
Across 539 active internal medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (SC) | G61794 | |
| 05 (GA) | 643358747A | |
| 01 (LA) | MD.201018 | MD LICENSE |
| 01 (GA) | 061794 | GA LICENSE |
Part of a multi-provider practice. 67 other active providers share this practice address in NPPES.
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