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General NPI Number Information
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NPI Number | 1215666318
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Entity Type | Organization
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Legal Business Name | JOY PEDIATRIC,LLC
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 101 ELLIOTT DR NW STE D
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City | ROME
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State | GA
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Zip | 30165-1154
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Country | US
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Telephone | 706-237-7314
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Fax |
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Provider Business Mailing Address
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Address Line | 101 ELLIOTT DR NW STE D
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City | ROME
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State | GA
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Zip | 30165-1154
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Country | US
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Telephone | 706-237-7314
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Fax |
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Authorized Official
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Title or Position | COO/ADMINISTRATOR
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Name | MRS. JENNIFER LYNN DUKE
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Credential | LPN
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Telephone | 706-237-7314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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