NPI age
20 years
Enumerated 2005-07-07
Across 2726 active pediatrics providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 52821173 | BLUE CROSS/BLUE SHIELD |
| 05 (GA) | 714506728A |
Solo or small practice. No other active providers share this practice address in NPPES.
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