Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 11931 | GA |
NPI | 1003431545 |
---|---|
Provider Name | Kristen Schmidbauer |
First Address | Evans, GA 30809-0690 |
Second Address | Augusta, GA 30912-0012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2020 |
Last Update Date | 10/06/2020 |