NPI age
19 years
Enumerated 2006-11-09
Across 643 active internal medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 00715371B | |
| 01 (GA) | 041305 | STATE LICENSE |
Part of a multi-provider practice. 5 other active providers share this practice address in NPPES.
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