NPI age
19 years
Enumerated 2006-08-25
Across 138 active pediatrics providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 297003 | WELLCARE |
| 05 (GA) | 611384188A | |
| 05 (GA) | 913725245A | |
| 05 (GA) | 000739296C | |
| 01 (GA) | 000739296C | PEACH STATE HEALTH PLAN |
| 01 (GA) | 000739296D | PEACH STATE HEALTH PLAN |
| 01 (GA) | 10033063 | AMERIGROUP |
| 01 (GA) | 297026 | WELLCARE |
| 01 (GA) | 58-2624216 | TAX IDENTIFICATION NUMBER |
| 01 (GA) | 166056 | BLUE CROSS BLUE SHIELD |
| 05 (GA) | 000739296D |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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