NPI age
14 years
Enumerated 2012-05-22
Across 5027 active internal medicine providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (MO) | 1508126780 | |
| 05 (KS) | 201124300A | |
| 01 (MO) | P01584894 | RR MEDICARE |
Part of a multi-provider practice. 138 other active providers share this practice address in NPPES.
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