NPI age
20 years
Enumerated 2006-03-21
Across 2726 active pediatrics providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 000849318E | |
| 01 | 10596269 | CAQH |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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