Provider Demographics
NPI:1033428610
Name:GEORGETOWN PEDIATRICS
Entity Type:Organization
Organization Name:GEORGETOWN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-392-6555
Mailing Address - Street 1:11 DUNWOODY PARK
Mailing Address - Street 2:SUITE 190
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7408
Mailing Address - Country:US
Mailing Address - Phone:770-392-6555
Mailing Address - Fax:
Practice Address - Street 1:11 DUNWOODY PARK
Practice Address - Street 2:SUITE 190
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-7408
Practice Address - Country:US
Practice Address - Phone:770-392-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty