Organization
CONYERS PEDIATRICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALICIA W SENN (PRACTICE ADMINISTRATOR)
(770) 922-5745
Entity
Organization
Contact information
Practice address
1277B WELLBROOK CIR NE, CONYERS, GA 30012-3873
(770) 922-5745
(770) 922-4924
Mailing address
1277B WELLBROOK CIR NE, CONYERS, GA 30012-3873
(770) 922-5745
(770) 922-4924
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4544
AETNA
GA
05
—
85000351G
—
GA
Enumeration date
03/26/2007
Last updated
08/22/2020
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