KID STATION PEDIATRICS P.C
Medical Practice at Medical Dr, Lagrange, GA

License number
Georgia 058657
Category
Medical Practice
Type
Pediatrics
Owner
Name: KALYANI ANGAMPALLY RAJEEV M.D
Title: OWNER
Phone: (678) 481-7879
Address
Address
301 Medical Dr SUITE 504, Lagrange, GA 30240
National Provider ID: 1720213952
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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KID STATION PEDIATRICS P.C

301 Medical Dr SUITE 504, Lagrange, GA 30240

Industry:
Medical Doctor's Office
Registration:
Apr 24, 2009
State ID:
09029519
Business type:
Domestic Professional Corporation
Principals:
Angampally Kalyani Rajeev (CEO), 301 Medical Dr #13, Lagrange, GA 30240 (Physical),S Lakshmi Mandavilli (Secretary), 265 Laketrail Dr, Alpharetta, GA 30022 (Physical),Kalyani A. Rajeev (Medical Doctor, Owner, Principal),...
Agent:
Kalyani A Rajeev,409 Park Ave, Lagrange, GA (Physical)

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