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Organization

KIDCARE PEDIATRICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. CHAUNCEY DANIELS (CEO)
(404) 765-9437
Entity
Organization

Contact information

Practice address
910 DANNON VW SW STE 2101, ATLANTA, GA 30331-2156
(404) 691-6100
(404) 691-6959
Mailing address
910 DANNON VW SW STE 2101, ATLANTA, GA 30331-2156
(404) 691-6100
(404) 691-6959

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
302R00000X
Health Maintenance Organization
057447
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000359675H
GA
Enumeration date
10/06/2006
Last updated
09/16/2020
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