Organization
THE PEDIATRIC CENTER OF STONE MOUNTAIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALICIA CHADWICK (MEDICAL HOME SPECIAL PROJECTS)
(678) 763-2615
Entity
Organization
Contact information
Practice address
5405 MEMORIAL DR STE D, STONE MOUNTAIN, GA 30083-3236
(404) 296-3800
Mailing address
5405 MEMORIAL DR STE D, STONE MOUNTAIN, GA 30083-3236
(404) 296-3800
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300021562A
—
GA
Enumeration date
04/06/2016
Last updated
04/06/2016
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