Healthcare Provider Details

I. General information

NPI: 1912224577
Provider Name (Legal Business Name): BRIGHT PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2010
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 E WALNUT AVE
DALTON GA
30721-8724
US

IV. Provider business mailing address

2918 E WALNUT AVE
DALTON GA
30721-8724
US

V. Phone/Fax

Practice location:
  • Phone: 706-529-4600
  • Fax: 706-529-4633
Mailing address:
  • Phone: 706-483-9613
  • Fax: 706-529-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50126
License Number StateGA

VIII. Authorized Official

Name: RAMI AZZOUZ
Title or Position: MD/OWNER
Credential: MD
Phone: 706-529-4600