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General NPI Number Information
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NPI Number | 1225296155
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Entity Type | Organization
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Legal Business Name | JONESBORO PEDIATRICS
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 236 ARROWHEAD BLVD
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City | JONESBORO
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State | GA
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Zip | 30236-1106
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Country | US
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Telephone | 770-478-9240
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Fax | 770-478-0318
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Provider Business Mailing Address
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Address Line | 236 ARROWHEAD BLVD
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City | JONESBORO
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State | GA
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Zip | 30236-1106
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Country | US
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Telephone | 770-478-9240
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Fax | 770-478-0318
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | ROMEO R MORILES
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Credential | MD
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Telephone | 770-478-9240
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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 |
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License Number State |
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