NPI age
13 years
Enumerated 2012-06-05
Across 94 active colon & rectal surgery providers in Georgia.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (RI) | MD18095 | STATE MEDICAL LICENSE |
| 05 (GA) | 1992066161 |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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