NPI age
7 years
Enumerated 2019-04-09
Across 1405 active specialist/technologist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | AT002377 | GEORGIA SECRETARY OF STATE |
| 01 | BOC217903 | BOARD OF CERTIFICATION |
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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