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General NPI Number Information
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NPI Number | 1770207482
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Entity Type | Organization
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Legal Business Name | SURF AND SAND PEDIATRICS
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Dates
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Enumeration Date | 09/27/2022
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 1111 GLYNCO PKWY STE 31
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City | BRUNSWICK
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State | GA
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Zip | 31525-7930
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Country | US
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Telephone | 912-456-3605
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Fax | 912-456-3531
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Provider Business Mailing Address
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Address Line | 1111 GLYNCO PKWY STE 31
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City | BRUNSWICK
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State | GA
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Zip | 31525-7930
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGED CARE DIRECTOR
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Name | DEBRA BERRY
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Credential |
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Telephone | 912-445-4387
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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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