Organization
CARROLLTON PEDIATRIC CLINIC, P.C.
Active
Other names
Westcare Pediatric and Family Care
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA HALL (OFFICE MANAGER)
(770) 832-1103
Entity
Organization
Contact information
Practice address
410 NEWNAN ST, CARROLLTON, GA 30117-3111
(770) 832-1103
(770) 832-1142
Mailing address
410 NEWNAN ST, CARROLLTON, GA 30117-3111
(770) 832-1103
(770) 832-1142
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11D0934505
CLIA
GA
05
—
300025719A
—
GA
Enumeration date
09/22/2006
Last updated
06/21/2018
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