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General NPI Number Information
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NPI Number | 1548496169
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Entity Type | Organization
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Legal Business Name | PROMISE PEDIATRICS LLC
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 375 BOYNTON DR
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City | RINGGOLD
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State | GA
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Zip | 30736-2737
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Country | US
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Telephone | 706-937-3331
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Fax | 706-937-3346
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Provider Business Mailing Address
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Address Line | 375 BOYNTON DR
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City | RINGGOLD
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State | GA
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Zip | 30736-2737
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Country | US
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Telephone | 706-937-3331
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Fax | 706-937-3346
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CHRISTINE BAUGHMAN
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Credential |
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Telephone | 706-937-3331
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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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