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NPI Code Detail

MEDICARE: KIDS-DOC-ON-WHEELS

MEDICARE: KIDS-DOC-ON-WHEELS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497277404
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDS-DOC-ON-WHEELS
Provider Business Mailing Address
First Line : 4112 E PONCE DE LEON AVE # 2
Second Line :
City : CLARKSTON
State : GA
Zip : 30021-8106
Country : US
Telephone Number : 404-574-2512
Fax Number : 404-296-7211
Provider Business Practice Location Address
First Line : 4112 E PONCE DE LEON AVE # 2
Second Line :
City : CLARKSTON
State : GA
Zip : 30021-8106
Country : US
Telephone Number : 404-574-2512
Fax Number : 404-296-7211
Authorized Official
Title or Position : BOARD OF DIRECTORS
Name : DR. LYNETTE R WILSON-PHILLIPS
Credential : MD
Telephone Number : 404-574-2512
Provider Enumeration Date : 07/11/2017
Last Update Date : 12/14/2017

Similar Medicare Providers

1366441032 — DR. PATRICE GIBSON CHISHOM MD
Practice Location Address:
4112 E PONCE DE LEON AVE
CLARKSTON, GA
30021-8106
Practice Phone: 404-289-7133
Practice Fax: 404-289-7211
1285621037 — DR. STEPHANIE M HENRY MD
Practice Location Address:
4112 E PONCE DE LEON AVE
CLARKSTON, GA
30021-8106
Practice Phone: 404-296-7133
Practice Fax: 404-296-7211
1922063734 — TRACY FERGUSON M.D.
Practice Location Address:
4112 E PONCE DE LEON AVE
CLARKSTON, GA
30021-8106
Practice Phone: 404-296-7133
Practice Fax: 404-296-7211
1962579631 — KEANNA L JOSEPH-CLARKE MD
Practice Location Address:
4112 E PONCE DE LEON AVE
CLARKSTON, GA
30021-8106
Practice Phone: 404-296-7133
Practice Fax: 404-296-7211
1376106534 — PREETHI RAJAN
Practice Location Address:
4112 E PONCE DE LEON AVE
CLARKSTON, GA
30021-8106
Practice Phone: 404-296-7133
Practice Fax:
1285278739 — MRS. EMILY SCHOBER KLINGMAN NP
Practice Location Address:
4112 E PONCE DE LEON AVE
CLARKSTON, GA
30021-8106
Practice Phone: 318-455-1870
Practice Fax:

Directions to “KIDS-DOC-ON-WHEELS ” Practice Location

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