Organization
MAMA DOC PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIZABETH LOGAN PENN M.D. (PHYSICIAN / PRESIDENT)
(912) 871-5437
Entity
Organization
Contact information
Practice address
400 EAST GRADY STREET, STATESBORO, GA 30458
(912) 871-5437
(912) 623-2037
Mailing address
400 EAST GRADY STREET, STATESBORO, GA 30458
(912) 871-5437
(912) 623-2037
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
67374
GA
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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