NPI age
20 years
Enumerated 2005-06-16
Across 437 active podiatrist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 753297511A | |
| 01 (IL) | 016-004067 | ILLINOIS LICENSE# |
| 01 (MS) | 80095 | MISSISSIPPI LICENSE# |
| 05 (GA) | 000360478A | |
| 01 (GA) | 1124171251 | ORGANIZATIONAL NPI |
| 01 (GA) | 575 | GEORGIA LICENSE# |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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