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Organization
LAKESIDE PEDIATRICS, LLC
Active
Organization
LAKESIDE PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOB B BAGHERI M.D. (PRESIDENT)
(770) 886-5437
Entity
Organization
Contact information
Practice address
204 CANTON RD, CUMMING, GA 30040-2304
(770) 886-5437
(770) 886-9717
Mailing address
11565 MOUNTAIN LAUREL DR, ROSWELL, GA 30075-1333
(770) 886-5437
(770) 886-9717
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
040865
GA
208000000X
Pediatrics Physician
050209
GA
Other
Enumeration date
12/19/2011
Last updated
12/19/2011
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