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General NPI Number Information
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NPI Number | 1497389795
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Entity Type | Organization
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Legal Business Name | LAURENS PEDIATRICS, LLC
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 112 ROWE ST
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City | DUBLIN
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State | GA
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Zip | 31021-5200
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Country | US
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Telephone | 478-272-5212
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Fax | 478-272-5217
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Provider Business Mailing Address
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Address Line | 112 ROWE ST
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City | DUBLIN
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State | GA
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Zip | 31021-5200
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Country | US
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Telephone | 478-272-5212
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Fax | 478-272-5217
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. KANNAN VAIDYANATHAN
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Credential | MD
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Telephone | 478-272-5212
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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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