Provider Demographics
NPI:1376288522
Name:SOUTHERN KIDS CARE, PC
Entity Type:Organization
Organization Name:SOUTHERN KIDS CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANICE
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-434-1400
Mailing Address - Street 1:239 LONGLEAF DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5265
Mailing Address - Country:US
Mailing Address - Phone:217-549-2232
Mailing Address - Fax:
Practice Address - Street 1:1801 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1572
Practice Address - Country:US
Practice Address - Phone:229-434-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty