Provider Demographics
NPI:1154453967
Name:SNELLVILLE PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:SNELLVILLE PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-972-0860
Mailing Address - Street 1:1700 TREE LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6782
Mailing Address - Country:US
Mailing Address - Phone:770-972-0860
Mailing Address - Fax:770-972-0850
Practice Address - Street 1:1700 TREE LN STE 110
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6749
Practice Address - Country:US
Practice Address - Phone:770-972-0860
Practice Address - Fax:770-972-0850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty