NPI age
20 years
Enumerated 2005-07-22
Across 5027 active internal medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 038834 | STATE LICENSE |
| 05 (GA) | 000623004B |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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