NPI age
19 years
Enumerated 2007-01-22
Across 36 active surgery providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (SC) | GA1597 | |
| 05 (GA) | 003109566F | |
| 01 (GA) | P01292127 | RAILROAD MEDICARE |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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