NPI age
20 years
Enumerated 2005-08-23
Across 450 active otolaryngology providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 031837 | PHYSICIAN LICENSE |
| 05 (GA) | 455142019D | |
| 01 (GA) | 11D1105865 | CLIA ID - 17 JOHNSON ST |
| 05 (GA) | 455142019C | |
| 01 (GA) | 11D1089117 | CLIA ID - 100 DOCTORS DR STE 201 |
| 01 (GA) | 341265 | WELLCARE |
| 01 (GA) | GRP7930 | CAHABA MEDICARE GROUP # |
| 01 (GA) | DH1281 | MEDICARE RAILROAD - GROUP # |
| 01 (GA) | P00726007 | MEDICARE RAILROAD - PTAN |
Solo or small practice. No other active providers share this practice address in NPPES.
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