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Contact Information

PEDIATRIC DIGESTIVE HEALTH AND WELLNESS
3925 HARRISON RD STE 100
LOGANVILLE, GA30052-5898
 Phone: 706-340-4330
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatric Gastroenterology

2080P0206X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for PEDIATRIC DIGESTIVE HEALTH AND WELLNESS

NPI Number 1083394266
LBN Legal business name PEDIATRIC DIGESTIVE HEALTH AND WELLNESS
Authorized official DERICA SAMS - (OWNER/ AUTHORIZED OFFICIAL)
Entity Organization
Organization subpart 1 No
Enumeration date 07/21/2023
Last updated 09/04/2024 - More than a year ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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