NPI age
20 years
Enumerated 2005-09-30
Across 5027 active internal medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 00316852B | |
| 05 (GA) | 00316852A | |
| 01 (GA) | 581759458 | TAX PAYER ID |
| 01 (GA) | 52238029 | BLUE CROSS/BLUE SHIELD |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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