Provider Demographics
NPI:1295724680
Name:THE CHILDREN'S DOCTORS PC
Entity type:Organization
Organization Name:THE CHILDREN'S DOCTORS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-866-7384
Mailing Address - Street 1:2366 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4030
Mailing Address - Country:US
Mailing Address - Phone:706-866-7384
Mailing Address - Fax:706-861-7003
Practice Address - Street 1:2366 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4030
Practice Address - Country:US
Practice Address - Phone:706-866-7384
Practice Address - Fax:706-861-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX IDENTIFICATION