NPI age
20 years
Enumerated 2005-08-10
Across 539 active internal medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 035587 | STATE LICENSE |
| 01 (GA) | 0030127 | BLUE CROSS BLUE SHIELD |
| 05 (GA) | 00511761A |
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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