Performance Pediatrics And Sports Medicine, Llc

NPI 1295081321 - Internal Medicine - 207R00000X

NPI Details
NPI 1295081321
Enumeration Date 07/26/2012
Last Updated 07/26/2012
Entity Type Healthcare Provider
Active Over 4 years ago
Authorized Information
Name TARA ANN TARA
Position OWNER PHYSICIAN
Phone (706) 207-6694
Fax
Practice Location
1181 LANGFORD DR
BLDG 200-101
BOGART GA, 30622-2542, US
Phone (706) 207-6694
Fax
Business Location
1181 LANGFORD DR
BLDG 200-101
BOGART GA, 30622-2542, US
Phone
Fax
Toxanomy
Taxonomy Code 207R00000X
License State Georgia
License Number 58543
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According to our database, Performance Pediatrics And Sports Medicine, Llc NPI is 1295081321, taxonomy code is 207R00000X and license number is 58543, license state is located at Georgia. Performance Pediatrics And Sports Medicine, Llc physically located at 1181 Langford Dr, Bogart GA, 30622-2542. NPI Number 1033115704 has the healthcare provider type.

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1295081321 NPI number is provided on an as is basis without warranty of any kind. 1295081321 is maintained by the National Plan & Provider Enumeration System. The contents of Performance Pediatrics And Sports Medicine, Llc are for informational purposes only.