NPI age
20 years
Enumerated 2006-01-28
Across 494 active internal medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (IN) | 201112810 | |
| 01 (IN) | 000000853232 | ANTHEM PROVIDER NUMBER |
| 01 (GA) | 55545 | GEORGIA MEDICAL LICENSE |
Part of a multi-provider practice. 76 other active providers share this practice address in NPPES.
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