NPI age
18 years
Enumerated 2008-05-21
Across 4616 active physician assistant providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (TN) | 1081766 | NCCPA ID |
| 01 (IN) | 10001620A | INDIANA STATE LICENSE |
| 01 (KY) | PA1835 | KENTUCKY STATE LICENSE |
| 01 (TN) | 1596 | TENNESSEE STATE LICENSE NUMBER |
| 01 (KY) | 12511065 | CAQH |
Part of a multi-provider practice. 238 other active providers share this practice address in NPPES.
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