NPI age
20 years
Enumerated 2005-08-10
Across 2726 active pediatrics providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (NH) | 01YP05102NH02 | ANTHEM BC/BS |
| 01 | 5830418 | AETNA GROUP |
| 01 | P00100688 | RAILROAD MEDICARE |
| 01 (NH) | 11867 | STATE LICENSE # |
| 01 (NH) | 2184240001 | CIGNA HEALTHCARE |
| 01 | 020350051 | FEDERAL TAX ID |
| 05 (NH) | 30204719 |
Part of a multi-provider practice. 321 other active providers share this practice address in NPPES.
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