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General NPI Number Information
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NPI Number | 1982776159
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Entity Type | Organization
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Legal Business Name | GAHANNA PEDIATRICS, LLC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 470 SILVER LANE SUITE B
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City | GAHANNA
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State | OH
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Zip | 43230
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Country | US
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Telephone | 614-933-0980
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Fax | 614-933-0334
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Provider Business Mailing Address
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Address Line | 470 SILVER LANE SUITE B
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City | GAHANNA
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State | OH
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Zip | 43230
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Country | US
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Telephone | 614-933-0980
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Fax | 614-933-0334
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SHERI M KELSEY
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Credential |
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Telephone | 614-933-0980
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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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