Organization
GC DULUTH PEDIATRICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL SONG (PRESIDENT)
(678) 417-0407
Entity
Organization
Contact information
Practice address
3435 DULUTH PARK LN STE A, DULUTH, GA 30096-3259
(678) 417-0407
Mailing address
3435 DULUTH PARK LN STE A, DULUTH, GA 30096-3259
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
049206
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
442074795A
—
GA
Enumeration date
03/30/2012
Last updated
03/30/2012
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