Organization
LOGANVILLE PEDIATRICS & ADOLESCENT CARE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN TULLIS (OFFICE MANAGER)
(770) 466-6112
Entity
Organization
Contact information
Practice address
3815 HARRISON RD, LOGANVILLE, GA 30052-2462
(770) 466-6112
(770) 466-6201
Mailing address
3815 HARRISON RD, LOGANVILLE, GA 30052-2462
(770) 466-6112
(770) 466-6201
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Enumeration date
07/28/2006
Last updated
04/22/2024
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