NPI age
19 years
Enumerated 2007-05-24
Across 62 active exclusive provider organization providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 1871544775 | INDIVIDUAL NPI#1871544775 |
| 01 (GA) | 052340 | LICENSE# 052340 |
Single-site organization. Only one practice location on file.
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