Healthcare Provider Details

I. General information

NPI: 1003680372
Provider Name (Legal Business Name): GEORGIA PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 ETHAN ALLEN HIGHWAY UNIT 1
GEORGIA VT
05468
US

IV. Provider business mailing address

927 ETHAN ALLEN HIGHWAY UNIT 1
GEORGIA VT
05468
US

V. Phone/Fax

Practice location:
  • Phone: 802-527-2237
  • Fax: 802-527-2267
Mailing address:
  • Phone: 802-527-2237
  • Fax: 802-527-2267

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. MICHAEL EDWARD VISKER
Title or Position: PRESIDENT
Credential: MD
Phone: 802-318-1416