NPI age
20 years
Enumerated 2006-04-20
Across 5448 active family medicine providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (NC) | 891253P | MCAID |
| 01 (GA) | 39463 | LICENSE |
| 05 (GA) | 00946393A |
Solo or small practice. No other active providers share this practice address in NPPES.
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