NPI age
20 years
Enumerated 2005-08-16
Across 414 active internal medicine providers in Georgia.
5 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (OH) | 2402046 | |
| 01 (GA) | G18732A | MEDICARE |
| 05 (GA) | 003232464A | |
| 05 (IN) | 300021480 |
Part of a multi-provider practice. 6 other active providers share this practice address in NPPES.
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