| NPI | 1437493467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANAGED CARE Mgr, Provider Enrollment 404-785-7876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology |
| 2080P0201X Pediatrics, Pediatric Allergy/Immunology | |
| 2080P0205X Pediatrics, Pediatric Endocrinology | |
| 2080P0206X Pediatrics, Pediatric Gastroenterology | |
| 2080P0208X Pediatrics, Pediatric Infectious Diseases | |
| 2080P0210X Pediatrics, Pediatric Nephrology | |
| 2080P0214X Pediatrics, Pediatric Pulmonology | |
| 2080P0216X Pediatrics, Pediatric Rheumatology | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2025-01-16 |