Organization
THE PEDIATRIC OFFICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KEELYN CLARK CUNNINGHAM (OFFICE MANAGER)
(706) 854-2600
Entity
Organization
Contact information
Practice address
4321 UNIVERSITY PKWY, SUITE 104, EVANS, GA 30809-3058
(706) 854-2600
(706) 854-2601
Mailing address
4321 UNIVERSITY PKWY, SUITE 104, EVANS, GA 30809-3058
(706) 854-2600
(706) 854-2601
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300035984A
—
GA
Enumeration date
05/27/2006
Last updated
11/05/2008
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