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General NPI Number Information
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NPI Number | 1093992117
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Entity Type | Organization
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Legal Business Name | PEDS 'R US, P.C.
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 1606 NORWICH ST
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City | BRUNSWICK
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State | GA
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Zip | 31520-6761
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Country | US
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Telephone | 913-262-1039
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Fax | 912-275-8320
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Provider Business Mailing Address
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Address Line | PO BOX 1098 1606 NORWICH STREET
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City | BRUNSWICK
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State | GA
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Zip | 31521-1098
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Country | US
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Telephone | 913-262-1039
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Fax | 912-275-8320
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. LOURDES DE ARMAS
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Credential | M.D.
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Telephone | 912-262-1039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | GA 043917
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License Number State | GA
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