Organization
DAHLONEGA PEDIATRIC AND ADOLESCENT MEDICINE
Active
Other names
Dahlonega Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE CORN (PROVIDER/OWNER)
(706) 864-6700
Entity
Organization
Contact information
Practice address
1055 NORTH GROVE ST., DAHLONEGA, GA 30533
(706) 864-6700
(706) 864-2599
Mailing address
1055 NORTH GROVE ST, DAHLONEGA, GA 30533
(706) 864-6700
(706) 864-2599
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
RN068135
GA
261QR1300X
Rural Health Clinic/Center
Primary
11-8910
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000548369C
—
GA
Enumeration date
10/14/2011
Last updated
05/04/2015
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