NPI age
19 years
Enumerated 2007-05-15
Across 5448 active family medicine providers in Georgia.
1 individual provider on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | A002 | TRICARE |
| 05 (GA) | 00253096H | |
| 01 (GA) | 202G086627 | MEDICARE PTAN |
Doing-business-as, former, and alternate names recorded by NPPES.
Multi-provider organization. 1 individual provider on file at this primary address.
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