Provider Demographics
NPI:1255012753
Name:PEDSNOW LLC
Entity type:Organization
Organization Name:PEDSNOW LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-391-1044
Mailing Address - Street 1:863 W OGLETHORPE HWY STE 220
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4491
Mailing Address - Country:US
Mailing Address - Phone:912-391-1044
Mailing Address - Fax:
Practice Address - Street 1:2321 POOLER PARKWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322
Practice Address - Country:US
Practice Address - Phone:912-391-1044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDSNOW LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-27
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty