Provider Demographics
NPI:1003680372
Name:GEORGIA PEDIATRICS, PC
Entity Type:Organization
Organization Name:GEORGIA PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:VISKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-318-1416
Mailing Address - Street 1:927 ETHAN ALLEN HIGHWAY
Mailing Address - Street 2:UNIT 1
Mailing Address - City:GEORGIA
Mailing Address - State:VT
Mailing Address - Zip Code:05468
Mailing Address - Country:US
Mailing Address - Phone:802-527-2237
Mailing Address - Fax:802-527-2267
Practice Address - Street 1:927 ETHAN ALLEN HIGHWAY
Practice Address - Street 2:UNIT 1
Practice Address - City:GEORGIA
Practice Address - State:VT
Practice Address - Zip Code:05468
Practice Address - Country:US
Practice Address - Phone:802-527-2237
Practice Address - Fax:802-527-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty