Organization
PEDIATRIC CARDIOLOGY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM AHMED RMM (PRACTICE ADMINISTRATOR)
(770) 995-6684
Entity
Organization
Contact information
Practice address
500 MEDICAL CENTER BLVD, 340, LAWRENCEVILLE, GA 30046-8708
(770) 995-6684
(770) 995-7631
Mailing address
500 MEDICAL CENTER BLVD, 340, LAWRENCEVILLE, GA 30046-8708
(770) 995-6684
(770) 995-7631
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
020857
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
700216987A
—
GA
Enumeration date
10/03/2011
Last updated
10/03/2011
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