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General NPI Number Information
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NPI Number | 1740407550
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Entity Type | Organization
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Legal Business Name | EAGLES LANDING PEDIATRIC ASSOCIATES LLC
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1101 HOSPITAL DR SUITE 210
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-9075
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Country | US
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Telephone | 678-289-0103
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Fax | 678-289-0171
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Provider Business Mailing Address
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Address Line | 1101 HOSPITAL DR SUITE 210
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-9075
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Country | US
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Telephone | 678-289-0103
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Fax | 678-289-0171
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Authorized Official
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Title or Position | OWNERPHYSICIAN
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Name | STEVEN WAYNE LEARD
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Credential | MD
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Telephone | 678-289-0103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 040449
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License Number State | GA
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