Provider Demographics
NPI:1366569485
Name:BI-COUNTY PEDIATRICS
Entity type:Organization
Organization Name:BI-COUNTY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:P
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:770-949-3888
Mailing Address - Street 1:6128 PRESTLEY MILL RD STE D
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5622
Mailing Address - Country:US
Mailing Address - Phone:770-949-3888
Mailing Address - Fax:770-949-3504
Practice Address - Street 1:6128 PRESTLEY MILL RD STE D
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5622
Practice Address - Country:US
Practice Address - Phone:770-949-3888
Practice Address - Fax:770-949-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020701208000000X
GA058682208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA30022158CMedicaid