NPI age
19 years
Enumerated 2006-09-15
Across 1678 active psychiatry & neurology providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 26BDKDP | PTAN |
| 01 (GA) | 27-4711138 | FED TAX ID - PRIVATE PRACTICE |
| 01 (GA) | 052124 | MEDICAL LIC - GEORGIA |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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