Organization
LIFE CYCLE PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GWENDOLYN WILLIAMS (OFFICE MANAGER)
(404) 228-0601
Entity
Organization
Contact information
Practice address
428 WINN CT STE 100A, DECATUR, GA 30030-1726
(404) 228-0601
(470) 698-2141
Mailing address
428 WINN CT STE 100A, DECATUR, GA 30030-1726
(404) 228-0601
(470) 698-2141
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
894980142A
—
GA
05
—
894980142D
—
GA
Enumeration date
04/10/2018
Last updated
04/10/2018
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