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General NPI Number Information
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NPI Number | 1942333588
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCIATES OF BRUNSWICK
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3208 SHRINE RD
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City | BRUNSWICK
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State | GA
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Zip | 31520-4325
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Country | US
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Telephone | 912-265-2036
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Fax | 912-265-6779
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Provider Business Mailing Address
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Address Line | 3208 SHRINE RD
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City | BRUNSWICK
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State | GA
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Zip | 31520-4325
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Country | US
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Telephone | 912-265-2036
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Fax | 912-265-6779
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEPHEN JAMES THOMPSON
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Credential | M.D.
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Telephone | 912-265-2036
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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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