Provider Demographics
NPI:1982865408
Name:MIDDLE GEORGIA PEDIATRICS
Entity Type:Organization
Organization Name:MIDDLE GEORGIA PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:EPPS
Authorized Official - Last Name:HODGIN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, CCC-SLP
Authorized Official - Phone:478-731-3677
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:DRY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:31020-0010
Mailing Address - Country:US
Mailing Address - Phone:478-731-3677
Mailing Address - Fax:478-405-0363
Practice Address - Street 1:4149 ARKWRIGHT RD
Practice Address - Street 2:SUITE D
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1732
Practice Address - Country:US
Practice Address - Phone:478-731-3677
Practice Address - Fax:478-405-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency