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Organization

WOODSTOCK PEDIATRIC MEDICINE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KELLY MARULANDA (PRACTICE MANAGER)
(770) 517-0250
Entity
Organization

Contact information

Practice address
2000 PROFESSIONAL WAY, BLDG 200, WOODSTOCK, GA 30188-4093
(770) 517-0250
(770) 517-0260
Mailing address
2000 PROFESSIONAL WAY, BLDG 200, WOODSTOCK, GA 30188-4093
(770) 517-0250
(770) 517-0260

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
085001488G
GA
Enumeration date
05/04/2007
Last updated
03/21/2012
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