NPI age
17 years
Enumerated 2009-01-09
Across 5448 active family medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 0846248429 | ADVANCED CARDIAC LIFE SUPPORT PROVIDER CERTIFICATION |
| 01 (GA) | 202I081470 | PTAN# |
| 01 (GA) | 12268599 | CAQH PROVIDER ID# |
| 01 (GA) | 65963 | GA STATE LICENSE# |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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