Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Locust Grove Pediatrics

Organization Pediatrics Physician · NPI 1174693519

Locust Grove Pediatrics is a Pediatrics Physician in Locust Grove, Georgia. Licensed in Georgia. Registered with an NPI since 2006.

Licensed in
GA
In the registry since
2006

Practice location Address checks out

5040 Bill Gardner Pkwy Ste 100
Locust Grove, GA 30248-3645
Phone: (678) 583-5437
Fax: (678) 583-5484
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X · Licence 041469 (GA)

Record details

NPI number1174693519
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official John Mynatt — Owner · (678) 583-5437
NPI enumeratedNovember 9, 2006
Last updated in NPPESSeptember 10, 2007
Mailing address5040 Bill Gardner Pkwy, Suite 100, Locust Grove, GA 30248-3645

Other providers in Locust Grove