NPI age
14 years
Enumerated 2011-07-03
Across 539 active internal medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (PA) | MT200444 | PA LICENSING |
| 01 (GA) | 74515 | GA LICENSE NUMBER |
Part of a multi-provider practice. 816 other active providers share this practice address in NPPES.
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