NPI age
19 years
Enumerated 2006-06-20
Across 5448 active family medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 044023 | GA MEDICAL LIC |
| 01 (IL) | 36092640 | ILLINOIS MEDICAL LIC |
| 01 (GA) | 11343981 | CAQH IDENTIFIER |
| 05 (GA) | 000762088D |
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
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