NPI age
18 years
Enumerated 2007-06-28
Across 2726 active pediatrics providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 286300162A | |
| 01 (GA) | 064081 | GA LICENSES |
| 01 (GA) | 002452 | RESIDENCY TRAINING PERMIT |
Part of a multi-provider practice. 10 other active providers share this practice address in NPPES.
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