NPI age
12 years
Enumerated 2013-06-25
Across 2726 active pediatrics providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 003166378B | |
| 01 (GA) | 075881 | MEDICAL LICENSE |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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