Healthcare Provider Details

I. General information

NPI: 1851676589
Provider Name (Legal Business Name): DR.SOOS PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 BOWLING LN
DUBLIN GA
31021-2502
US

IV. Provider business mailing address

102 BOWLING LN
DUBLIN GA
31021-2502
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-0203
  • Fax: 478-272-0223
Mailing address:
  • Phone: 478-272-0203
  • Fax: 478-272-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS MALLORY LEE
Title or Position: BILLING/CREDENTIALING
Credential:
Phone: 478-272-0203