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Organization
MEADOW PEDIATRICS, PLLC
Active
Organization
MEADOW PEDIATRICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SRIDEVI MUTHUKUMAR MD (OWNER)
(310) 707-8359
Entity
Organization
Contact information
Practice address
10710 MEDLOCK BRIDGE RD STE 250, JOHNS CREEK, GA 30097-1827
(310) 707-8359
(770) 825-9001
Mailing address
10710 MEDLOCK BRIDGE RD STE 250, JOHNS CREEK, GA 30097-1827
(310) 707-8359
(770) 825-9001
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
63377
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
558938842B
—
GA
Enumeration date
08/14/2012
Last updated
08/14/2012
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