NPI age
20 years
Enumerated 2006-02-24
Across 1389 active surgery providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 020697 | STATE LICENSE |
| 05 (GA) | 00262721B | |
| 05 (GA) | 000262721F |
Part of a multi-provider practice. 122 other active providers share this practice address in NPPES.
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