NPI age
19 years
Enumerated 2007-01-18
Across 2726 active pediatrics providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 319585 | |
| 01 (GA) | 826405 | BLUE CROSS BLUE SHIELD |
| 05 (GA) | 000716592F |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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