Organization
MAIN STREET INTERNAL MEDICINE & PEDIATRICS PC
Active
Other names
Main Street Pediatrics PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIBEL LABINDALAWA ANGKA SERVERA MD (PHYSICIAN)
(678) 205-2437
Entity
Organization
Contact information
Practice address
401 S MAIN ST, SUITE C5, ALPHARETTA, GA 30009-7960
(678) 205-2437
(678) 205-2439
Mailing address
401 S MAIN ST, SUITE C5, ALPHARETTA, GA 30009-7960
(678) 205-2437
(678) 205-2439
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
047657
GA
208000000X
Pediatrics Physician
Primary
047388
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000860054D
—
GA
05
—
000884804C
—
GA
Enumeration date
02/05/2008
Last updated
01/22/2009
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