Organization
LIFE CYCLE PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GWENDOLYN WILLIAMS (OFFICE MANAGER)
(404) 228-0601
Entity
Organization
Contact information
Practice address
150 MEDICAL WAY STE B, RIVERDALE, GA 30274-2533
(770) 692-2800
(770) 692-2804
Mailing address
2739 FELTON DR, EAST POINT, GA 30344-3603
(404) 766-8371
(404) 767-3926
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578526539
—
GA
Enumeration date
09/01/2021
Last updated
09/01/2021
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