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General NPI Number Information
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NPI Number | 1629356670
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PULMONOLOGY OF CENTRAL GA
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 1062 FORSYTH ST SUITE 2 C
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City | MACON
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State | GA
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Zip | 31201-8637
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Country | US
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Telephone | 478-755-0036
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Fax | 478-755-1254
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Provider Business Mailing Address
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Address Line | 1062 FORSYTH ST SUITE 2 C
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City | MACON
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State | GA
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Zip | 31201-8637
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Country | US
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Telephone | 478-755-0036
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Fax | 478-755-1254
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Authorized Official
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Title or Position | BILLING MGR
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Name | TAMMY R COBB
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Credential |
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Telephone | 478-755-0036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number |
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License Number State |
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