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Organization

GOLDEN ISLES PEDIATRICS INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. HEATHER A SVENSON M.D. (PRESIDENT)
(912) 265-4843
Entity
Organization

Contact information

Practice address
1919 GLYNN AVE, SUITE 60, BRUNSWICK, GA 31520-6176
(912) 265-4843
(912) 265-4869
Mailing address
1919 GLYNN AVE, SUITE 60, BRUNSWICK, GA 31520-6176
(912) 265-4843
(912) 265-4869

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
050841
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10061954
AMERIGROUP PROVIDER #
GA
01
33619
WELLCARE HEALTH PLAN
GA
01
336419
WELLCARE
GA
05
699850421A
GA
Enumeration date
08/31/2006
Last updated
01/30/2012
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