Organization
PRIME PEDIATRICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBBIE W CHADWICK (OFFICE MANAGER)
(706) 279-1994
Entity
Organization
Contact information
Practice address
1610 BROADRICK DR, DALTON, GA 30720-3012
(706) 279-1994
(706) 279-9229
Mailing address
1610 BROADRICK DR, DALTON, GA 30720-3012
(706) 279-1994
(706) 279-9229
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
37896
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000572525C
—
GA
05
—
000910214A
—
GA
05
—
803486775A
—
GA
05
—
964266319A
—
GA
Enumeration date
05/22/2008
Last updated
05/22/2008
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