NPI age
20 years
Enumerated 2005-07-14
Across 5027 active internal medicine providers in Georgia.
3 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 559998689A | GBHC PROVIDER NUMBER |
| 05 (GA) | 000469147X | |
| 05 (GA) | 000469147AC |
Part of a multi-provider practice. 6 other active providers share this practice address in NPPES.
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