Healthcare Provider Details

I. General information

NPI: 1033773858
Provider Name (Legal Business Name): NEIGHBORHOOD PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HOBBS STREET
BLACKSHEAR GA
31516
US

IV. Provider business mailing address

125 HOBBS STREET
BLACKSHEAR GA
31516
US

V. Phone/Fax

Practice location:
  • Phone: 912-530-7337
  • Fax: 912-530-7339
Mailing address:
  • Phone:
  • Fax: 912-530-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KANDIE MEDLOCK
Title or Position: OFFICE MANAGER
Credential:
Phone: 912-530-7337