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Organization
SOUTHERN CRESCENT PEDIATRICS PC
Active
Organization
SOUTHERN CRESCENT PEDIATRICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUAN JOSE SHERWOOD MD (PRESIDENT)
(770) 389-9944
Entity
Organization
Contact information
Practice address
191 FAIRVIEW RD, ELLENWOOD, GA 30294-2722
(770) 389-5500
(770) 389-4959
Mailing address
150 MEDICAL BLVD, STE B, STOCKBRIDGE, GA 30281-5053
(770) 389-9944
(770) 389-1973
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0526682
AETNA SELECT/US HEALTHC
—
01
—
276714
BCBS
—
01
—
7802
KAISER POS
—
Enumeration date
09/20/2005
Last updated
08/22/2020
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