NPI age
20 years
Enumerated 2005-10-03
Across 100 active pediatrics providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (AL) | 009928300 | |
| 01 (AL) | 1528055753 | TRICARE SOUTH |
| 01 (AL) | 510-95530 | BCBS |
| 01 (AL) | 5656157 | AETNA |
Part of a multi-provider practice. 61 other active providers share this practice address in NPPES.
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