Healthcare Provider Details

I. General information

NPI: 1639346471
Provider Name (Legal Business Name): SANDY PLAINS PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 SHALLOWFORD RD SUITE1300
MARIETTA GA
30062-1266
US

IV. Provider business mailing address

3225 SHALLOWFORD RD SUITE1300
MARIETTA GA
30062-1266
US

V. Phone/Fax

Practice location:
  • Phone: 678-560-7160
  • Fax: 678-560-7185
Mailing address:
  • Phone: 678-560-7160
  • Fax: 678-560-7185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number041831
License Number StateGA

VIII. Authorized Official

Name: DR. LAURETTE HO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 678-560-7160