NPI age
19 years
Enumerated 2007-05-17
Across 681 active psychiatry & neurology providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 060163 | LICENSE |
| 05 (GA) | REF204099017 | |
| 01 (GA) | 511I130039 | MEDICARE ID |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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