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Griffin, Georgia

Provider NPI: 1639351596

Provider Information:

Practice Location:
Tel: 770-634-1998  Fax: --

Business Mailing Address:
Tel: --  Fax: --


PrimaryCodeCategory/DescriptionStateLicense Number
Psychiatry & Neurology

Other Provider Identifiers:

AETNA - PPO4567388GA01
AETNA - HMO2339303GA01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin

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