NPI age
19 years
Enumerated 2006-07-21
Across 5448 active family medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 52277036-003 | BLUE CROSS BLUE SHIELD |
| 01 (GA) | 23929 | MEDICAL LICENSE |
| 05 (GA) | 000290749B | |
| 01 (GA) | 11D1048614 | CLIA # |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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