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General NPI Number Information
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NPI Number | 1255012753
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Entity Type | Organization
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Legal Business Name | PEDSNOW LLC
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 12/29/2023
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Provider Practice Location Address
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Address Line | 2321 POOLER PARKWAY SUITE 102
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City | POOLER
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State | GA
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Zip | 31322
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Country | US
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Telephone | 912-391-1044
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Fax |
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Provider Business Mailing Address
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Address Line | 863 W OGLETHORPE HWY STE 220
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City | HINESVILLE
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State | GA
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Zip | 31313-4491
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Country | US
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Telephone | 912-391-1044
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PHILLIP AJAYI
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Credential |
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Telephone | 912-391-1044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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