Organization
KIDCARE PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAUNCEY DANIELS (CEO)
(404) 765-9437
Entity
Organization
Contact information
Practice address
2565 JOLLY RD STE A, COLLEGE PARK, GA 30349-3103
(404) 765-9437
(404) 669-9347
Mailing address
2565 JOLLY RD STE A, COLLEGE PARK, GA 30349-3103
(404) 765-9437
(404) 669-9347
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
302F00000X
Exclusive Provider Organization
027494
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000359675G
—
GA
Enumeration date
10/05/2006
Last updated
09/16/2020
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