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General NPI Number Information
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NPI Number | 1750509634
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Entity Type | Organization
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Legal Business Name | KIDS CHOICE PEDIATRICS,LLC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2775 CRUSE RD SUITE 1801
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7140
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Country | US
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Telephone | 678-380-9199
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Fax | 770-935-0199
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Provider Business Mailing Address
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Address Line | 2775 CRUSE RD SUITE 1801
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7140
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Country | US
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Telephone | 678-380-9199
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Fax | 770-935-0199
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Authorized Official
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Title or Position | MEMBER
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Name | DR. VENKATESWARA RAO DIKKALA
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Credential | M.D.
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Telephone | 678-380-9199
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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 | 048226
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License Number State | GA
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