Organization
BRASELTON PEDIATRICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARC-YRIANE BORIEUX M.D. (PRESIDENT)
(419) 787-8685
Entity
Organization
Contact information
Practice address
1897 HIGHWAY 211 NW, SUITE 100, HOSCHTON, GA 30548
(678) 820-7979
(678) 820-7980
Mailing address
1651 TAILMORE LN, LAWRENCEVILLE, GA 30043-7862
(678) 820-7979
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
059604
STATE OF GEORGIA MEDICAL LICENSE
—
01
—
1700095742
NPI
GA
Enumeration date
09/17/2008
Last updated
09/17/2008
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