| Developmental Behavioral Pediatrics | |
|
100 Professional Pl Ste 104 Carrollton GA 30117-3874 | |
| (770) 830-7039 | |
| (770) 830-7149 |
| Full Name | Developmental Behavioral Pediatrics |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 100 Professional Pl, Carrollton, Georgia |
| Authorized Official Name and Position | Jack W Miller (PHYSICIAN) |
| Authorized Official Contact | 7708307039 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Developmental Behavioral Pediatrics 100 Professional Pl Ste 104 Carrollton GA 30117-3874 Ph: (770) 830-7039 | Developmental Behavioral Pediatrics 100 Professional Pl Ste 104 Carrollton GA 30117-3874 Ph: (770) 830-7039 |
| NPI Number | 1982708368 |
|---|---|
| Provider Enumeration Date | 09/07/2006 |
| Last Update Date | 02/02/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982708368 | NPI | - | NPPES |
| 000767709C | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 044541 (Georgia) | Primary |
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