NPI age
17 years
Enumerated 2008-06-30
Across 160 active radiology providers in Georgia.
4 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 300030405A | |
| 01 | 1962664086 | NPI |
| 05 (FL) | 009840200 |
Part of a multi-provider practice. 689 other active providers share this practice address in NPPES.
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