NPI age
19 years
Enumerated 2007-03-04
Across 643 active internal medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 300052394 | TAX I.D. FOR OTHER INSURA |
| 05 (GA) | 000403147A | |
| 01 (GA) | 102I100129 | PTAN |
| 01 (GA) | 202I100956 | PTAN |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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