Provider Demographics
NPI:1497389795
Name:LAURENS PEDIATRICS, LLC
Entity Type:Organization
Organization Name:LAURENS PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KANNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAIDYANATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-272-5212
Mailing Address - Street 1:112 ROWE ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-5200
Mailing Address - Country:US
Mailing Address - Phone:478-272-5212
Mailing Address - Fax:478-272-5217
Practice Address - Street 1:112 ROWE ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-5200
Practice Address - Country:US
Practice Address - Phone:478-272-5212
Practice Address - Fax:478-272-5217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty