Organization
SPIRIT OF KEY WEST LLC
Active
Other names
Suwanahoochee Pediatrics, Lake Lanier Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
JANA RENEE HIMMELBAUM DO (OWNER)
(678) 765-8622
Entity
Organization
Contact information
Practice address
5629 HOLIDAY RD, BUFORD, GA 30518-1519
(678) 765-8622
(678) 765-8621
Mailing address
5629 HOLIDAY RD, BUFORD, GA 30518-1519
(678) 765-8622
(678) 765-8621
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
75152
GA
Other
Enumeration date
12/05/2016
Last updated
03/07/2025
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