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General NPI Number Information
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NPI Number | 1053749457
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Entity Type | Organization
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Legal Business Name | PLEASANT PEDS CARE OF CONYERS LLC
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Dates
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Enumeration Date | 10/22/2013
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Last Update Date | 10/22/2013
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Provider Practice Location Address
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Address Line | 1415 MILSTEAD RD NE STE. C
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City | CONYERS
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State | GA
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Zip | 30012-3841
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Country | US
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Telephone | 404-966-2972
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 MILSTEAD RD NE STE. C
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City | CONYERS
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State | GA
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Zip | 30012-3841
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Country | US
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Telephone | 404-966-2972
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHYRONDA PLEASANT
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Credential | MD
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Telephone | 404-966-2972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 51999
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License Number State | GA
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