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Organization
SUNNYSIDE PEDIATRICS
Active
Organization
SUNNYSIDE PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRABHUDEV PATRE MD (DIRECTOR)
(770) 715-4808
Entity
Organization
Contact information
Practice address
600 S 8TH ST, GRIFFIN, GA 30224-4214
(770) 233-4668
(678) 866-2636
Mailing address
600 S 8TH ST, GRIFFIN, GA 30224-4214
(770) 233-4668
(678) 866-2636
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
055272
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
785450399C
—
GA
Enumeration date
11/11/2011
Last updated
11/11/2011
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