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Organization
KIDS TIME PEDIATRICS OF SOUTHERN CRESCENT, LLC
Active
Organization
KIDS TIME PEDIATRICS OF SOUTHERN CRESCENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FLYNN CLYBURN (PRESIDENT)
(706) 342-2180
Entity
Organization
Contact information
Practice address
115 SUMNER RD, SUITE D, FAYETTEVILLE, GA 30214-4758
(706) 342-2180
Mailing address
696 BILLUPS AVE, MADISON, GA 30650-1439
(706) 342-2180
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
NULL
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Enumeration date
03/13/2007
Last updated
08/22/2020
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