NPI age
20 years
Enumerated 2005-06-26
Across 21 active psychiatry & neurology providers in Georgia.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 79002 | GA LICENSE |
| 05 (IA) | 2115774 |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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