NPI age
19 years
Enumerated 2006-07-21
Across 85 active emergency medicine providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (KY) | R0961 | LICENSE |
| 01 (IN) | 01063853A | INDIANA STATE LICENSE |
Solo or small practice. No other active providers share this practice address in NPPES.
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