South Georgia Pediatrics, P.c.

NPI #1578797627 in Statesboro, Georgia

Provider Information

NPI Number: 1578797627
Entity Type: Organization
Organization Name: South Georgia Pediatrics, P.c.
Primary Specialty: Specialist
Enumeration Date: May 5, 2009
Last Updated: May 7, 2009

Practice Location

Address: 1230 BRAMPTON AVE
City: Statesboro
State: Georgia
ZIP Code: 30458-0849
Phone: (912) 489-5437

Authorized Official

Name: RAO TULASI IMMANENI, M.D., F.A.A.P.
Title: CEO
Phone: (912) 247-0409

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X
Specialist	174400000X	Primary

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