NPI age
20 years
Enumerated 2006-04-26
Across 108 active internal medicine providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 767974652C | |
| 01 (GA) | 222969 | ABIM DIPLOMATE NUMBER |
| 05 (GA) | 767974652A | |
| 05 (GA) | 767974652B | |
| 01 (GA) | 053367 | GEORGIA MEDICAL LICENSE |
Solo or small practice. No other active providers share this practice address in NPPES.
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