NPI age
20 years
Enumerated 2006-05-25
Across 5448 active family medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (IN) | 01045490A | INDIANA LICENSE |
| 01 (NY) | 198714 | NEW YORK LICENSE |
| 01 (IN) | 01045490B | CSR |
| 01 (NJ) | 25MA06176700 | NEW JERSEY LICENSE |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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