Organization
PEDIAKARE OF NEWNAN, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE B DARRAH M.D. (CEO)
(706) 243-4500
Entity
Organization
Contact information
Practice address
1111 BULLSBORO DR, SUITE 6 AND 7, NEWNAN, GA 30265-2182
(706) 615-4736
(706) 221-6226
Mailing address
PO BOX 9007, COLUMBUS, GA 31908-9007
(706) 615-4736
(706) 221-6226
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
065633
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
440194601
—
AR
Enumeration date
04/07/2011
Last updated
04/07/2011
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