NPI age
20 years
Enumerated 2006-02-27
Across 437 active podiatrist providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 4418670001 | DMERC NUMBER |
| 05 (GA) | 000925878A | |
| 01 (GA) | POD000924 | PODIATRY LICENSE |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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