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Organization
THE PEDIATRIC CENTER OF STONE MOUNTAIN
Active
Organization
THE PEDIATRIC CENTER OF STONE MOUNTAIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALICIA CHADWICK (MEDICAL HOME SPECIAL PROJECTS)
(678) 763-2615
Entity
Organization
Contact information
Practice address
5405 MEMORIAL DR STE D, STONE MOUNTAIN, GA 30083-3236
(404) 296-3800
Mailing address
5405 MEMORIAL DR STE D, STONE MOUNTAIN, GA 30083-3236
(404) 296-3800
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300021562A
—
GA
Enumeration date
04/06/2016
Last updated
04/06/2016
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