NPI age
19 years
Enumerated 2006-08-14
Across 1881 active specialist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 00608704B | |
| 01 (GA) | PT002390 | PT LICENSE |
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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