Organization
KIDS AVENUE PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHYLLIS STEMBRIDGE (PRACTICE MANAGER)
(770) 909-8007
Entity
Organization
Contact information
Practice address
1720 PHOENIX BLVD, SUITE900, COLLEGE PARK, GA 30349-5594
(770) 909-8007
(770) 909-8005
Mailing address
1720 PHOENIX BLVD, SUITE900, COLLEGE PARK, GA 30349-5594
(770) 909-8007
(770) 909-8005
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
027036
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
497361413A
—
GA
Enumeration date
06/24/2008
Last updated
06/24/2008
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