NPI age
19 years
Enumerated 2007-02-21
Across 2726 active pediatrics providers in Georgia.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 003128452A | |
| 01 (FL) | ME 104615 | MEDICAL STATE LICENSE |
| 05 (KY) | 7100047720 | |
| 05 (GA) | 003128452AC | |
| 05 (IN) | 200907860 |
Part of a multi-provider practice. 6 other active providers share this practice address in NPPES.
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