NPI age
20 years
Enumerated 2006-05-20
Across 5448 active family medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (SC) | 25806 | STATE LICENSE |
| 05 (GA) | 467902058A |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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