Organization
MPPG, INC.
Active
Other names
Backus Children's Hospital Outpatient Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization
Contact information
Practice address
1120 15TH ST, ATTN: PEDIATRIC ENDO CLINIC, AUGUSTA, GA 30912-0004
(706) 721-2695
(706) 721-0416
Mailing address
PO BOX 102032, ATLANTA, GA 30368-2032
(706) 721-2695
(706) 721-0416
Taxonomy
Speciality
Code
Description
License number
State
2080P0205X
Pediatric Endocrinology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP3905
MEDICARE GROUP
GA
Enumeration date
08/15/2007
Last updated
06/01/2011
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