NPI age
14 years
Enumerated 2011-07-29
Across 221 active internal medicine providers in Georgia.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (IN) | 01080554A | INDIANA MEDICAL LICENSE |
Part of a multi-provider practice. 24 other active providers share this practice address in NPPES.
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