NPI age
19 years
Enumerated 2006-08-01
Across 1280 active radiology providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (MI) | 3005100322 | BCBSM INDIVIDUAL PIN |
| 05 (MI) | 4799171 |
Solo or small practice. No other active providers share this practice address in NPPES.
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