Organization
DECATUR PEDIATRIC GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYNETTE R WILSON-PHILLIPS M.D. (PRESIDENT)
(404) 296-7133
Entity
Organization
Contact information
Practice address
4112 E PONCE DE LEON AVE, CLARKSTON, GA 30021-1817
(404) 296-7133
(404) 296-7211
Mailing address
4112 E PONCE DE LEON AVE, CLARKSTON, GA 30021-1817
(404) 296-7133
(404) 296-7211
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
038132
GA
Other
Enumeration date
01/18/2007
Last updated
08/22/2020
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