NPI age
20 years
Enumerated 2006-03-14
Across 5027 active internal medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 11D0942926 | CLIA |
| 01 (GA) | 52670227 | BC/BS OF GA |
| 01 (GA) | 331639 | WELLCARE |
| 05 (GA) | 000752375A | |
| 01 (GA) | 040804 | GA LICENSE |
| 01 (GA) | 110149299 | RR MEDICARE/METRAHEALTH |
Part of a multi-provider practice. 6 other active providers share this practice address in NPPES.
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