NPI age
20 years
Enumerated 2005-11-15
Across 640 active physician assistant providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 202I975412 | MEDICARE PTAN |
| 01 (GA) | 1619959756 | NATIONAL PROVIDER IDENTIFIER |
| 05 (GA) | 100002796A |
Part of a multi-provider practice. 17 other active providers share this practice address in NPPES.
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