Organization
OUR VILLAGE PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN GLAESER (OFFICE MANAGER)
(470) 389-4970
Entity
Organization
Contact information
Practice address
115 ACADEMY ST, CANTON, GA 30114-2860
(470) 389-4970
Mailing address
115 ACADEMY ST, CANTON, GA 30114-2860
(470) 389-4970
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
04/30/2020
Last updated
04/30/2020
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