NPI age
15 years
Enumerated 2011-04-11
Across 563 active clinic/center providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 003131929A | |
| 01 (GA) | 11D2024784 | CLIA |
Doing-business-as, former, and alternate names recorded by NPPES.
Single-site organization. Only one practice location on file.
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