NPI age
17 years
Enumerated 2008-06-20
Across 5448 active family medicine providers in Georgia.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 808095300 | |
| 05 (OR) | 500640264 | |
| 01 (OR) | P01027050 | RR MEDICARE (PROVIDENCE) |
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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