NPI age
20 years
Enumerated 2006-02-03
Across 5027 active internal medicine providers in Georgia.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 000899797C | |
| 01 (GA) | 049523 | GA MEDICAL LICENSE |
| 01 (GA) | 112399 | PEACH STATE HEALTH PLAN |
| 01 (GA) | 01052398 | AMERIGROUP |
| 01 (GA) | 653835 | WELLCARE |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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