NPI age
19 years
Enumerated 2006-07-13
Across 1024 active hospitalist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (WY) | 124201600 | |
| 01 (WY) | 315033 | WY BLUE SHIELD |
| 01 (WY) | 7663A | STATE LICENSE # |
| 01 (WY) | 830261354 | CHAMPUS |
Part of a multi-provider practice. 689 other active providers share this practice address in NPPES.
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