NPI age
19 years
Enumerated 2006-06-10
Across 5448 active family medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 43745 | GA MEDICAL LICENSE |
| 05 (GA) | 00753673B | |
| 01 (GA) | CH0654 | RR MEDICARE GROUP PIN |
| 05 (SC) | G43745 | |
| 01 (GA) | 10056330 | AMERIGROUP |
| 01 (GA) | 337009 | WELLCARE |
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
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