Organization
EGLESTON PEDATRIC GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUETTA CODY (MANAGER, PROVIDER ENROLLMENT)
(404) 785-7876
Entity
Organization
Contact information
Practice address
2620 SATELLITE BLVD, DULUTH, GA 30096-1204
(404) 785-8000
Mailing address
1584 TULLIE CIR NE, ATLANTA, GA 30329-2311
(404) 785-7928
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
01/22/2007
Last updated
04/03/2023
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