NPI age
19 years
Enumerated 2006-11-01
Across 5448 active family medicine providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 0033301568A | |
| 05 (WI) | 34735900 | |
| 01 (WI) | 49060-020 | STATE MEDICAL LICENSE |
| 01 (GA) | 95184 | LICENSE |
Solo or small practice. No other active providers share this practice address in NPPES.
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