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General NPI Number Information
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NPI Number | 1841580420
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCITAES OF LAWRENCEVILLE, LLC
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Dates
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Enumeration Date | 04/15/2011
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 755 OLD NORCROSS RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4317
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Country | US
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Telephone | 770-277-6725
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Fax |
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Provider Business Mailing Address
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Address Line | 755 OLD NORCROSS RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4317
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Country | US
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Telephone | 770-277-6725
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANURADHA SHETH
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Credential | MD
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Telephone | 770-277-6725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN173289
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License Number State | GA
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