NPI age
18 years
Enumerated 2007-07-17
Across 276 active internal medicine providers in Georgia.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (SC) | TL34875 | STATE LICENSE |
| 01 (GA) | 70547 | STATE MEDICAL LICENSES |
Part of a multi-provider practice. 10 other active providers share this practice address in NPPES.
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