Basic Information
| Provider Information | |||||||||
| NPI: | 1750714804 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEDIATRIA HEALTHCARE, LLC | ||||||||
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| OtherOrganizationName: | PEDIATRIA HEALTHCARE FOR KIDS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5185 PEACHTREE PKWY | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | NORCROSS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300926542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708401966 | ||||||||
| FaxNumber: | 7708401901 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 BERRYHILL RD | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292106470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708401966 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2013 | ||||||||
| LastUpdateDate: | 08/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | DIGNAN | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 7708401966 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | JD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | Y | Agencies | Nursing Care |
No ID Information.