# BRASELTON PEDIATRICS, PC

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

## Provider details

- **NPI number:** 1194974907
- **Authorized official:** MARC-YRIANE BORIEUX M.D. (PRESIDENT)
- **Authorized official phone:** (419) 787-8685

## Contact information

- **Practice address:** 1897 HIGHWAY 211 NW, SUITE 100, HOSCHTON, GA 30548
- **Practice address phone:** (678) 820-7979
- **Practice address fax:** (678) 820-7980
- **Mailing address:** 1651 TAILMORE LN, LAWRENCEVILLE, GA 30043-7862
- **Mailing address phone:** (678) 820-7979

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | GA | Yes |

## Other

- **Enumeration date:** 09/17/2008
- **Last updated:** 09/17/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 059604 | STATE OF GEORGIA MEDICAL LICENSE | — |
| 01 | — | 1700095742 | NPI | GA |