NPI age
19 years
Enumerated 2006-08-29
Across 84 active obstetrics & gynecology providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (VA) | 45748 | OPTIMA SENTARA ID# |
| 01 (VA) | 160043283Q | RAILROAD MEDICARE ID# |
| 01 (VA) | 541467765 | TAX ID# |
| 05 (VA) | 006210082 | |
| 01 (VA) | 20507 | VIRGINIA PREMIER ID # |
| 01 (VA) | 952279 | AETNA ID# |
| 01 (GA) | 90992 | STATE LICENSE |
| 01 (VA) | 5414523 | AETNA |
| 01 (VA) | 271664 | ANTHEM BC/BS ID# |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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