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Providence Pediatrics, Llc
Primary Care Clinic/Center in Tucker, Georgia
NPI 1104086800

Providence Pediatrics, Llc is a Primary Care Clinic/Center based in Stone Mountain, GA and is specialized in Primary Care. Providence Pediatrics, Llc practices in Tucker, GA. The NPI Number for Providence Pediatrics, Llc is 1104086800 and holds a License No. 041796 (Georgia).

The current practice location address for Providence Pediatrics, Llc is 2171 Northlake Pkwy, Tucker, GA and can be reached out via phone at 770-939-7477 and via fax at 770-939-7750.

Location: 2171 Northlake Pkwy, Tucker, GA, 30087-0014
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1104086800
Provider Name
Providence Pediatrics, Llc
Credential
Provider Entity Type
Organization
Address
2171 Northlake Pkwy, Tucker, GA, 30087-0014
Phone Number
770-939-7477
Fax Number
770-939-7750
Provider Enumeration Date
06/16/2008
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
2171 Northlake Pkwy
City
Tucker
State
Georgia
Zip
30084-4104
Phone Number
770-939-7477
Fax Number
770-939-7750
person
Provider Business Mailing Address Details
Address
2171 Northlake Pkwy
City
Tucker
State
Georgia
Zip
30084-4104
Phone Number
770-939-7477
Fax Number
770-939-7750
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Primary Care
Taxonomy
261QP2300X
License No.
041796 (Georgia)
Definition
Definition to come...
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