Provider Demographics
NPI:1467063248
Name:KINDERCARE PEDIATRICS OF GEORGIA
Entity Type:Organization
Organization Name:KINDERCARE PEDIATRICS OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-242-3791
Mailing Address - Street 1:174 ROYAL OAK DR
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-5624
Mailing Address - Country:US
Mailing Address - Phone:912-242-3791
Mailing Address - Fax:
Practice Address - Street 1:174 ROYAL OAK DR
Practice Address - Street 2:
Practice Address - City:GUYTON
Practice Address - State:GA
Practice Address - Zip Code:31312-5624
Practice Address - Country:US
Practice Address - Phone:912-677-3765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty