NPI age
20 years
Enumerated 2006-02-17
Across 54 active surgery providers in Georgia.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (AL) | 000038806 | ALABAMA MEDICAID |
| 01 (LA) | 1479764 | MEDICAID OF LOUISIANA |
| 01 (GA) | 074898 | MEDICAL LICENSE |
| 01 (AL) | 051038806 | BCBS |
| 01 (TN) | 3092225 | TENNCARE |
| 01 (TN) | 4045899 | TENNESSEE MEDICAID |
Part of a multi-provider practice. 362 other active providers share this practice address in NPPES.
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