NPI age
19 years
Enumerated 2007-01-30
Across 5448 active family medicine providers in Georgia.
1 individual provider on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 037562 | STATE LICENSE NUMBER |
| 05 (GA) | 00838318A | |
| 01 (GA) | 702182 | BCBS PROVIDER NUMBER |
| 01 (GA) | 00665 | BCBS GROUP NUMBER |
Multi-provider organization. 1 individual provider on file at this primary address.
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