Organization
WALTON CHILDREN'S CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBBA K EBBA MD (PRESIDENT)
(770) 207-5437
Entity
Organization
Contact information
Practice address
98 TARA COMMONS DR, SUITE 400, LOGANVILLE, GA 30052-8031
(770) 207-5437
(770) 207-7263
Mailing address
98 TARA COMMONS DR, SUITE 400, LOGANVILLE, GA 30052-8031
(770) 207-5437
(770) 207-7263
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036724
GA
Other
Enumeration date
09/01/2014
Last updated
09/23/2015
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