NPI age
19 years
Enumerated 2006-09-21
Across 1881 active specialist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 054175 | GEORGIA MEDICAL LICENSE |
| 01 (GA) | 1942315635 | NPI NUMBER |
| 05 (GA) | 824346200A |
Single-site organization. Only one practice location on file.
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