NPI age
19 years
Enumerated 2006-08-08
Across 437 active podiatrist providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 769029729A | |
| 01 (GA) | 202458594 | TAX ID |
| 01 | 800578 | BLUE CROSS BLUE SHIELD |
Solo or small practice. No other active providers share this practice address in NPPES.
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