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General NPI Number Information
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NPI Number | 1992127856
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCIATES OF NEWNAN P.C.
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 775 POPLAR RD SUITE 150
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City | NEWNAN
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State | GA
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Zip | 30265-8300
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Country | US
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Telephone | 770-400-8450
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Fax | 770-400-8451
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Provider Business Mailing Address
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Address Line | 775 POPLAR RD SUITE 150
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City | NEWNAN
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State | GA
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Zip | 30265-8300
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Country | US
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Telephone | 770-400-8450
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Fax | 770-400-8451
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT LAFAYETTE WHIPPLE IV
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Credential | M.D.
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Telephone | 770-400-8450
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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 | 046279
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License Number State | GA
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