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General NPI Number Information
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NPI Number | 1912115452
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Entity Type | Organization
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Legal Business Name | PEDS AND PARENTS FAMILY CARE, LLC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 124 ANDREWS WAY SUITE B
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City | KINGSLAND
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State | GA
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Zip | 31548-6860
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Country | US
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Telephone | 912-729-7007
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Fax | 912-729-3627
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Provider Business Mailing Address
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Address Line | 124 ANDREWS WAY SUITE B
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City | KINGSLAND
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State | GA
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Zip | 31548-6860
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Country | US
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Telephone | 912-729-7007
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Fax | 912-729-3627
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY LEE CARTER
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Credential | M.D.
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Telephone | 912-729-7007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 54592
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License Number State | GA
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