NPI age
17 years
Enumerated 2008-07-03
Across 2726 active pediatrics providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 | 01366392 | AMERIGROUP |
| 05 (GA) | 217496162A | |
| 05 (SC) | G62581 |
Part of a multi-provider practice. 10 other active providers share this practice address in NPPES.
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