NPI age
19 years
Enumerated 2006-08-08
Across 2726 active pediatrics providers in Georgia.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (OK) | 200902370A | |
| 05 (AR) | 239398001 | |
| 05 (GA) | 452405206N | |
| 05 (MO) | 200082724 |
Part of a multi-provider practice. 9 other active providers share this practice address in NPPES.
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