NPI age
16 years
Enumerated 2009-05-26
Across 2726 active pediatrics providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 075112 | GA COMPOSITE MEDICAL BOARD |
| 01 (GA) | 102I370895 | MEDICARE PTAN |
| 05 (GA) | 003170656A | |
| 05 (GA) | 003170656B |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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