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General NPI Number Information
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NPI Number | 1376288522
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Entity Type | Organization
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Legal Business Name | SOUTHERN KIDS CARE, PC
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 1801 PALMYRA RD
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City | ALBANY
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State | GA
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Zip | 31701-1572
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Country | US
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Telephone | 229-434-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 239 LONGLEAF DR
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City | LEESBURG
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State | GA
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Zip | 31763-5265
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Country | US
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Telephone | 217-549-2232
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANICE B ROBERTS
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Credential | MD
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Telephone | 229-434-1400
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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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