NPI age
19 years
Enumerated 2007-05-24
Across 57 active family medicine providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 003143127A | |
| 01 (GA) | 202I087630 | MEDICARE PTAN |
| 05 (LA) | 1035769 |
Part of a multi-provider practice. 6 other active providers share this practice address in NPPES.
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