Organization
KIDS TIME PEDIATRICS OF SOUTHERN CRESCENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FLYNN CLYBURN (PRESIDENT)
(706) 342-2180
Entity
Organization
Contact information
Practice address
115 SUMNER RD, SUITE D, FAYETTEVILLE, GA 30214-4758
(706) 342-2180
Mailing address
696 BILLUPS AVE, MADISON, GA 30650-1439
(706) 342-2180
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Enumeration date
03/13/2007
Last updated
08/22/2020
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