NPI age
19 years
Enumerated 2007-01-24
Across 5027 active internal medicine providers in Georgia.
4 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (SC) | G32421 | |
| 01 | 110102923 | RAILROAD MEDICARE |
| 01 | 11D0687551 | CLIA # FOR GROUP |
| 05 (GA) | 00453032D |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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