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General NPI Number Information
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NPI Number | 1932389608
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ENDOCRINE ASSOCIATES, PC
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 1100 LAKE HEARN DR NE SUITE 350
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City | ATLANTA
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State | GA
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Zip | 30342-1523
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Country | US
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Telephone | 404-255-0015
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Fax | 404-845-3080
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Provider Business Mailing Address
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Address Line | 1100 LAKE HEARN DR NE SUITE 350
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City | ATLANTA
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State | GA
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Zip | 30342-1523
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Country | US
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Telephone | 404-255-0015
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Fax | 404-845-3080
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MR. MARK A. SPANGLER
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Credential |
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Telephone | 404-255-1267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | 25935
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License Number State | GA
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