NPI age
19 years
Enumerated 2006-12-29
Across 2726 active pediatrics providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 354428 | WELLCARE |
| 05 (GA) | 000372391G | |
| 01 (GA) | 10051619 | AMERIGROUP |
| 01 | 58-2643952 | TAX ID |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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