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General NPI Number Information
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NPI Number | 1184908188
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Entity Type | Organization
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Legal Business Name | CHILDREN'S MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 1680 MULKEY RD SUITE E
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City | AUSTELL
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State | GA
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Zip | 30106-1118
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Country | US
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Telephone | 770-941-5107
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Fax | 770-944-1013
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Provider Business Mailing Address
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Address Line | 1680 MULKEY RD SUITE E
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City | AUSTELL
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State | GA
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Zip | 30106-1118
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Country | US
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Telephone | 770-941-5107
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Fax | 770-944-1013
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Authorized Official
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Title or Position | OWNER/ PEDIATRICIAN
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Name | SHELLY-ANN MICHELA SALANDY
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Credential | M.D.
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Telephone | 770-941-5107
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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 | 057184
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License Number State | GA
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