Provider Demographics
NPI:1205001666
Name:PUTNAM PEDAITRICS, INC
Entity Type:Organization
Organization Name:PUTNAM PEDAITRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-485-8924
Mailing Address - Street 1:132C SPARTA HWY
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-8492
Mailing Address - Country:US
Mailing Address - Phone:706-485-8924
Mailing Address - Fax:
Practice Address - Street 1:132C SPARTA HWY
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-8492
Practice Address - Country:US
Practice Address - Phone:706-485-8924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty