Provider Demographics
NPI:1598101388
Name:VILLAGE PEDIATRICS, PC
Entity Type:Organization
Organization Name:VILLAGE PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-288-4142
Mailing Address - Street 1:1862 AUBURN RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1676
Mailing Address - Country:US
Mailing Address - Phone:678-288-4142
Mailing Address - Fax:678-288-4143
Practice Address - Street 1:1862 AUBURN RD
Practice Address - Street 2:SUITE 107
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1676
Practice Address - Country:US
Practice Address - Phone:678-288-4142
Practice Address - Fax:678-288-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty