NPI age
20 years
Enumerated 2006-01-20
Across 563 active urology providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 11D1105865 | CLIA ID - 17 JOHNSON ST |
| 01 (GA) | 046695 | PHYSICIAN LICENSE # |
| 01 (GA) | 477420 | WELLCARE |
| 05 (GA) | 000833412D | |
| 05 (GA) | 000833412E | |
| 01 (GA) | 11D1092458 | CLIA ID - 200 DOCTORS DR STE 220 |
| 01 (GA) | DH1281 | RAILROAD MEDICARE - GROUP # |
| 01 (GA) | P00726011 | RAILROAD MEDICARE - PTAN |
Part of a multi-provider practice. 16 other active providers share this practice address in NPPES.
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