NPI age
20 years
Enumerated 2006-04-19
Across 539 active internal medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 555475686A | |
| 01 (GA) | P00200156 | RR MEDICARE |
| 01 (GA) | 0868802730 | CHAMPUS |
| 05 (GA) | 555475686B | |
| 01 (GA) | 161839 | BCBS |
Part of a multi-provider practice. 5 other active providers share this practice address in NPPES.
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