Provider Demographics
NPI:1942333588
Name:PEDIATRIC ASSOCIATES OF BRUNSWICK
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF BRUNSWICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-265-2036
Mailing Address - Street 1:3208 SHRINE RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4325
Mailing Address - Country:US
Mailing Address - Phone:912-265-2036
Mailing Address - Fax:912-265-6779
Practice Address - Street 1:3208 SHRINE RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4325
Practice Address - Country:US
Practice Address - Phone:912-265-2036
Practice Address - Fax:912-265-6779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty