NPI age
15 years
Enumerated 2010-06-11
Across 2726 active pediatrics providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 69581 | STATE LICENSE |
| 05 (GA) | 003133545A |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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