NPI age
19 years
Enumerated 2007-05-02
Across 640 active physician assistant providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (NY) | P54368 | NYS LICENSE |
| 01 (GA) | PA LICENSE 5783 | GEORGIA COMPOSITE STATE BOARD |
| 05 (GA) | 003133456A | |
| 05 (GA) | 003133456B | |
| 05 (GA) | 003133456C |
Part of a multi-provider practice. 178 other active providers share this practice address in NPPES.
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