NPI age
18 years
Enumerated 2007-07-19
Across 5448 active family medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (IL) | 036-117906 | STATE MEDICAL LICENSE |
| 01 (GA) | 060489 | STATE OF GEORGIA-COMPOSITE BAORD OF MEDICAL EXAMINERS |
Solo or small practice. No other active providers share this practice address in NPPES.
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