| Organization Name: | SUMTER PEDIATRICS LLC |
| NPI Number: | 1033502299 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NELSON MADRAZO (MANAGING MEMBER) |
| Mailing Address: | 340 Us Highway 19 S Leesburg |
| State: | GA US |
| Postal Code: | 317634872 |
| Phone Number: | 2298141174 |
| Fax Number: | |
| NPI Enumeration Date: | 03/12/2015 |
| NPI Last Update Date: | 04/20/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |