Organization
PEDIATRIC GASTROENTEROLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER IFEADIKE M.D. (PHYSICIAN/ OWNER)
(404) 508-5315
Entity
Organization
Contact information
Practice address
465 WINN WAY, SUITE 215, DECATUR, GA 30030-1753
(404) 508-5315
(404) 508-5313
Mailing address
PO BOX 922401, NORCROSS, GA 30010-2401
(404) 508-5315
(404) 508-5313
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0385519
GA
Other
Enumeration date
08/23/2006
Last updated
08/22/2020
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