Organization
VITAL PEDIATRICS FOR COMPLEX KIDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA SHEARER MD (PRESIDENT)
(404) 310-3252
Entity
Organization
Contact information
Practice address
1086 ARBOR TRCE NE, BROOKHAVEN, GA 30319-5378
(404) 310-3252
Mailing address
1086 ARBOR TRCE NE, BROOKHAVEN, GA 30319-5378
(404) 310-3252
Taxonomy
Speciality
Code
Description
License number
State
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80510
LICENSE
GA
Enumeration date
12/29/2020
Last updated
12/29/2020
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