NPI age
20 years
Enumerated 2006-05-12
Across 2726 active pediatrics providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 31709A002 | TRICARE |
| 05 (GA) | 00466925A | |
| 01 (GA) | 024953 | BLUE CROSS BLUE SHEILD |
| 05 (GA) | 000466925B |
Part of a multi-provider practice. 28 other active providers share this practice address in NPPES.
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