Provider Demographics
NPI:1912107079
Name:SOUTH DEKALB PEDIATRICS
Entity Type:Organization
Organization Name:SOUTH DEKALB PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JORON
Authorized Official - Middle Name:R
Authorized Official - Last Name:MURRY
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE, CPC
Authorized Official - Phone:404-243-9630
Mailing Address - Street 1:2395 WALL ST SE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2395 WALL ST SE
Practice Address - Street 2:SUITE 700
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6703
Practice Address - Country:US
Practice Address - Phone:404-243-9630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty