NPI age
19 years
Enumerated 2006-07-07
Across 681 active psychiatry & neurology providers in Georgia.
3 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (SC) | G43489 | |
| 01 (FL) | ME112191 | STATE LICENSE |
| 01 (GA) | 202I138999 | MEDICARE PTAN |
| 01 (GA) | P01290090 | RAILROAD MEDICARE |
Solo or small practice. No other active providers share this practice address in NPPES.
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