Organization
KID STATION PEDIATRICS P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KALYANI ANGAMPALLY RAJEEV M.D (OWNER)
(678) 481-7879
Entity
Organization
Contact information
Practice address
301 MEDICAL DR, SUITE 504, LAGRANGE, GA 30240-4144
(706) 882-5437
Mailing address
301 MEDICAL DR, SUITE 504, LAGRANGE, GA 30240-4144
(706) 882-5437
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
058657
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
416240451H
—
GA
Enumeration date
05/18/2009
Last updated
02/02/2012
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