Organization
LOCUST GROVE PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MYNATT JR. MD (OWNER)
(678) 583-5437
Entity
Organization
Contact information
Practice address
5040 BILL GARDNER PKWY, SUITE 100, LOCUST GROVE, GA 30248-3645
(678) 583-5437
(678) 583-5484
Mailing address
5040 BILL GARDNER PKWY, SUITE 100, LOCUST GROVE, GA 30248-3645
(678) 583-5437
(678) 583-5484
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
041469
GA
Other
Enumeration date
11/09/2006
Last updated
09/10/2007
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