NPI age
19 years
Enumerated 2006-12-14
Across 1114 active psychologist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 546540227A | |
| 01 (GA) | 311838737 | TAX IDENTIFICATION NUMBER |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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