Organization
VIBRANT KIDS PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL BURNETT DICKERSON MD (MANAGER)
(678) 423-5560
Entity
Organization
Contact information
Practice address
10 MARKET SQUARE WAY STE 100, NEWNAN, GA 30265-6078
(678) 423-5560
(678) 423-5563
Mailing address
87 TAPESTRY LN, NEWNAN, GA 30265-5649
(678) 423-5560
(678) 423-5563
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
061061
GA
Other
Enumeration date
11/04/2012
Last updated
11/04/2012
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