NPI age
9 years
Enumerated 2017-01-11
Across 4616 active physician assistant providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 13145 | GEORGIA COMPOSITE MEDICAL BOARD LICENSE |
| 01 (GA) | PT012604 | LICENSE NUMBER |
Part of a multi-provider practice. 537 other active providers share this practice address in NPPES.
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