Organization
SUWANEE PEDIATRICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BOLAJI T ODUSINA M.D. (MEDICAL DIRECTOR)
(678) 442-0205
Entity
Organization
Contact information
Practice address
1155 LAWRENCEVILLE SUWANEE RD, LAWRENCEVILLE, GA 30043-5425
(678) 442-0205
(678) 442-0185
Mailing address
1155 LAWRENCEVILLE SUWANEE RD, LAWRENCEVILLE, GA 30043-5425
(678) 442-0205
(678) 442-0185
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
042380
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000757567B
—
GA
05
—
647974880B
—
GA
Enumeration date
08/13/2009
Last updated
02/25/2011
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