Healthcare Provider Details

I. General information

NPI: 1982198073
Provider Name (Legal Business Name): HOPE PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 FAIRVIEW PARK DR
DUBLIN GA
31021
US

IV. Provider business mailing address

104 FAIRVIEW PARK DR
DUBLIN GA
31021-2500
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LEAH HELTON
Title or Position: OWNER
Credential: MD
Phone: 478-304-1414