| Providence Pediatrics, Llc | |
|
2171 Northlake Pkwy Suite 114 Tucker GA 30084-4104 | |
| (770) 939-7477 | |
| (770) 939-7750 |
| Full Name | Providence Pediatrics, Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2171 Northlake Pkwy, Tucker, Georgia |
| Authorized Official Name and Position | Erica Yvette Francis-scott (MANAGING MEMBER) |
| Authorized Official Contact | 7709397477 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Pediatrics, Llc Po Box 870527 Stone Mountain GA 30087-0014 Ph: (770) 939-7477 | Providence Pediatrics, Llc 2171 Northlake Pkwy Suite 114 Tucker GA 30084-4104 Ph: (770) 939-7477 |
| NPI Number | 1104086800 |
|---|---|
| Provider Enumeration Date | 06/16/2008 |
| Last Update Date | 11/04/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104086800 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 041796 (Georgia) | Primary |
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