NPI age
20 years
Enumerated 2006-01-27
Across 1881 active specialist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 00639944A | |
| 01 (GA) | 60054 | AETNA PROVIDR ID |
| 01 (GA) | 14108 | BLUE CROSS PROVIDER ID |
| 01 (GA) | 7018326 | CIGNA ID |
| 01 (GA) | 1060048 | QUALITY CARE ID |
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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