NPI age
20 years
Enumerated 2005-06-20
Across 5027 active internal medicine providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 0282107 | BC / BS OF GEORGIA |
| 01 | 58-1627574 | FEDERAL E.I.N. |
| 01 | 11D0257597 | CLIA |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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