NPI age
20 years
Enumerated 2005-07-26
Across 5027 active internal medicine providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 582278915 | TAX ID |
| 05 (GA) | 00436543B |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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