Locust Grove Pediatrics

NPI #1174693519 in Locust Grove, Georgia

Provider Information

NPI Number: 1174693519
Entity Type: Organization
Organization Name: Locust Grove Pediatrics
Primary Specialty: Pediatrics
Enumeration Date: Nov 9, 2006
Last Updated: Sep 10, 2007

Practice Location

Address: 5040 BILL GARDNER PKWY
Address 2: SUITE 100
City: Locust Grove
State: Georgia
ZIP Code: 30248-3645
Phone: (678) 583-5437

Authorized Official

Name: JOHN MYNATT JR., MD
Title: OWNER
Phone: (678) 583-5437

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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