Organization
PEDIATRIC CARDIOLOGY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIM WOODY RMM (PRACTICE ADMINISTRATOR)
(770) 995-6684
Entity
Organization
Contact information
Practice address
200 S ENOTA DR NE, SUITE 380, GAINESVILLE, GA 30501-3473
(770) 995-6684
(770) 995-7631
Mailing address
500 MEDICAL CENTER BLVD, SUITE 340, LAWRENCEVILLE, GA 30045-8708
(770) 995-6684
(770) 995-7631
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
043298
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000326873G
—
GA
05
—
00740891A
—
GA
Enumeration date
06/24/2008
Last updated
06/24/2008
Update your record
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