NPI age
13 years
Enumerated 2012-06-27
Across 2726 active pediatrics providers in Georgia.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (IN) | 201293770 | |
| 01 (IN) | IN2920002 | MEDICARE PTAN |
Part of a multi-provider practice. 5 other active providers share this practice address in NPPES.
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