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General NPI Number Information
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NPI Number | 1053578450
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Entity Type | Organization
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Legal Business Name | PRIME PEDIATRICS PC
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 1610 BROADRICK DR
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City | DALTON
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State | GA
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Zip | 30720-3012
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Country | US
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Telephone | 706-279-1994
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Fax | 706-279-9229
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Provider Business Mailing Address
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Address Line | 1610 BROADRICK DR
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City | DALTON
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State | GA
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Zip | 30720-3012
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Country | US
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Telephone | 706-279-1994
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Fax | 706-279-9229
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. DEBBIE W CHADWICK
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Credential |
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Telephone | 706-279-1994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 37896
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License Number State | GA
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