NPI age
20 years
Enumerated 2006-04-24
Across 14 active otolaryngology providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 040015437 | MEDICARE RAILROAD ID NO |
| 01 (GA) | 040364 | STATE LICENSE NUMBER |
| 05 (GA) | 00681227K | |
| 01 (GA) | 196754 | BCBS PROVIDER NUMBER |
Part of a multi-provider practice. 25 other active providers share this practice address in NPPES.
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