Organization
KIDS TIME PEDIATRICS OF GWINNETT LLC
Active
Other names
Kids Time Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
FLYNN CLYBURN (MANAGER)
(706) 342-2180
Entity
Organization
Contact information
Practice address
2695 SUGARLOAF PKWY, SUITE 200, LAWRENCEVILLE, GA 30045-9456
(404) 943-1979
Mailing address
696 BILLUPS AVE, MADISON, GA 30650-1439
(706) 342-2180
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
32201
GA
Other
Enumeration date
07/29/2011
Last updated
07/29/2011
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