Organization
WEST VININGS PEDIATRIC GROUP, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRYSTAL L/ WHITE M.D. (OWNER / M.D.)
(404) 446-3960
Entity
Organization
Contact information
Practice address
3644 HIGHLANDS PKWY SE, SMYRNA, GA 30082-5184
(404) 446-3960
(404) 446-3965
Mailing address
3644 HIGHLANDS PKWY SE, SMYRNA, GA 30082-5184
(404) 446-3960
(404) 446-3965
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
050747
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
683835419D
—
GA
Enumeration date
06/17/2013
Last updated
06/17/2013
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