Organization · Type 2 NPI

Providence Pediatrics, LLC

Primary Care Clinic/Center · Tucker, GA

NPI number 1104086800 Active

Practice location

2171 Northlake Pkwy, Suite 114
Tucker, GA 30084-4104

Call (770) 939-7477 Map

Fax (770) 939-7750

Mailing address

PO Box 870527
Stone Mountain, GA 30087-0014

Specialties and licenses

TaxonomyCodeLicense
Primary Care Clinic/Center Primary 261QP2300X041796 (GA)

Primary Care Clinic/Center: Definition to come...

7 other providers at this address

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About NPI 1104086800

Providence Pediatrics, LLC's National Provider Identifier is 1104086800, issued on Jun 16, 2008. The primary taxonomy on file is Primary Care Clinic/Center (261QP2300X), and the practice location is in Tucker, GA. The record was last updated on Nov 4, 2010.