Organization
PEDIATRIC CENTER FOR WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTEL G RUNNELS MBA (DIRECTOR OF OPERATIONS)
(678) 750-4000
Entity
Organization
Contact information
Practice address
1506 KLONDIKE RD SW STE 205, CONYERS, GA 30094-5173
(678) 750-4000
(678) 750-4005
Mailing address
1506 KLONDIKE RD SW STE 205, CONYERS, GA 30094-5173
(678) 750-3010
(678) 750-4005
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
58813
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003122586A
—
GA
Enumeration date
04/11/2012
Last updated
05/03/2024
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