Provider Demographics
NPI:1053325027
Name:LAWRENCEVILLE PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:LAWRENCEVILLE PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMERLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-962-8025
Mailing Address - Street 1:980 LAWRENCEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-4706
Mailing Address - Country:US
Mailing Address - Phone:770-962-8025
Mailing Address - Fax:770-822-1573
Practice Address - Street 1:980 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-4706
Practice Address - Country:US
Practice Address - Phone:770-962-8025
Practice Address - Fax:770-822-1573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty