NPI age
20 years
Enumerated 2005-10-11
Across 5448 active family medicine providers in Georgia.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 031176 | MEDICAL LICENSE |
| 05 (GA) | 00478882D |
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
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