NPI age
20 years
Enumerated 2006-03-17
Across 2726 active pediatrics providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 801551791A | |
| 01 (GA) | 161648019 | EMPLOYER IDENTIFICATION N |
| 05 (SC) | G46702 |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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