Organization
THE KIDS SPECIALIST HENRY PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNIE JOHNSON (INSURANCE COORDINATOR)
(678) 289-8184
Entity
Organization
Contact information
Practice address
1215 EAGLES LANDING PKWY, SUITE 108 & 109, STOCKBRIDGE, GA 30281-7279
(678) 289-8184
(678) 565-9856
Mailing address
1215 EAGLES LANDING PKWY, SUITE 108 & 109, STOCKBRIDGE, GA 30281-7279
(678) 289-8184
(678) 565-9856
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
045647
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00813942B
—
GA
05
—
00892746C
—
GA
Enumeration date
08/10/2010
Last updated
08/10/2010
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