Wellstar Medical Group East Paulding Pediatrics

NPI #1396738381 in Hiram, Georgia

Provider Information

NPI Number: 1396738381
Entity Type: Organization
Organization Name: Wellstar Medical Group East Paulding Pediatrics
Subpart: Yes (part of a larger organization)
Parent Organization: WELLSTAR MEDICAL GROUP
Primary Specialty: Specialist
Enumeration Date: Aug 25, 2005
Last Updated: Dec 8, 2011

Practice Location

Address: 51 HIRAM DR
City: Hiram
State: Georgia
ZIP Code: 30141-1844
Phone: (678) 945-8300

Authorized Official

Name: DR. KELLY DAVILLIER, MD
Title: PHYSICIAN
Phone: (678) 945-8320

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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