Healthcare Provider Details

I. General information

NPI: 1306973151
Provider Name (Legal Business Name): GA KIDZ PEDIATRICS. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 SYLVAN DR
JACKSON GA
30233-1548
US

IV. Provider business mailing address

146 SYLVAN DR
JACKSON GA
30233-1548
US

V. Phone/Fax

Practice location:
  • Phone: 770-775-4540
  • Fax: 770-775-4078
Mailing address:
  • Phone: 770-775-4540
  • Fax: 770-775-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LEZLIE F BILES
Title or Position: OWNER
Credential: MD
Phone: 770-775-4540