# LOGANVILLE PEDIATRICS & ADOLESCENT CARE ASSOCIATES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053325027
- **Authorized official:** ANN TULLIS (OFFICE MANAGER)
- **Authorized official phone:** (770) 466-6112

## Contact information

- **Practice address:** 3815 HARRISON RD, LOGANVILLE, GA 30052-2462
- **Practice address phone:** (770) 466-6112
- **Practice address fax:** (770) 466-6201
- **Mailing address:** 3815 HARRISON RD, LOGANVILLE, GA 30052-2462
- **Mailing address phone:** (770) 466-6112
- **Mailing address fax:** (770) 466-6201

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | NULL | Yes |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/28/2006
- **Last updated:** 04/22/2024