| Imagix Legacy Pediatrics Llc | |
|
3903 Jiles Rd Nw 210 Kennesaw GA 30144-4612 | |
| (770) 590-9050 | |
| Not Available |
| Full Name | Imagix Legacy Pediatrics Llc |
|---|---|
| Speciality | Dentist |
| Location | 3903 Jiles Rd Nw, Kennesaw, Georgia |
| Authorized Official Name and Position | Crystal Chouinard (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 9419553150 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Imagix Legacy Pediatrics Llc 3903 Jiles Rd Nw 210 Kennesaw GA 30144-4612 Ph: (770) 590-9050 | Imagix Legacy Pediatrics Llc 3903 Jiles Rd Nw 210 Kennesaw GA 30144-4612 Ph: (770) 590-9050 |
| NPI Number | 1295109015 |
|---|---|
| Provider Enumeration Date | 11/17/2015 |
| Last Update Date | 11/17/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295109015 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (Georgia) | Primary |
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