Organization
ST JOSEPH'S PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EFFIE S DOLORES MD (OWNER)
(770) 904-5252
Entity
Organization
Contact information
Practice address
4485 TENCH RD, STE 630, SUWANEE, GA 30024-6739
(770) 904-5252
Mailing address
4485 TENCH RD, STE 630, SUWANEE, GA 30024-6739
(770) 904-5252
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
043598
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000746281E
—
GA
Enumeration date
06/29/2007
Last updated
01/25/2012
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