NPI age
13 years
Enumerated 2013-02-19
Across 640 active physician assistant providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 | 1107991 | NCCPA CERTIFICATION |
| 01 (GA) | 202I971141 | MEDICARE PTAN |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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