Basic Information
| Provider Information | |||||||||
| NPI: | 1710280268 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PEDIATRIA HEALTHCARE FOR KIDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5185 PEACHTREE PKWY | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | NORCROSS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300926542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708401966 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5185 PEACHTREE PKWY | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | NORCROSS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300926542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708401966 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2010 | ||||||||
| LastUpdateDate: | 12/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | COFFIELD | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VP | ||||||||
| AuthorizedOfficialTelephone: | 7708401966 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3140N1450X | RN151537 | GA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility | Nursing Care, Pediatric |
No ID Information.