Organization
JEFFERSON PEDIATRICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY GAIL SMITH M.D. (OFFICER)
(706) 367-1010
Entity
Organization
Contact information
Practice address
2610 HIGHWAY 129 N, JEFFERSON, GA 30549-2652
(706) 367-1010
Mailing address
2610 HIGHWAY 129 N, JEFFERSON, GA 30549-2652
(706) 367-1010
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
038372
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00608253H
—
GA
01
—
10055116
AMERIGROUP
GA
01
—
309153
WELLCARE
GA
Enumeration date
02/07/2012
Last updated
02/07/2012
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