Organization
SUNFLOWER PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE S VAZ NP (MANAGER)
(404) 580-8022
Entity
Organization
Contact information
Practice address
5422 CUMMING HWY, SUGAR HILL, GA 30518-6906
(404) 580-8022
(770) 831-1119
Mailing address
5422 CUMMING HWY, SUGAR HILL, GA 30518
(404) 580-8022
(770) 831-1119
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN172992NP
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003142527C
—
GA
Enumeration date
07/14/2016
Last updated
07/14/2016
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