Basic Information
| Provider Information | |||||||||
| NPI: | 1841526829 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEDIATRIC ENDOCRINE ASSOCIATES II LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5909 PEACHTREE DUNWOODY RD NE | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303288102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4049430205 | ||||||||
| FaxNumber: | 4049430209 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 LAKE HEARN DR NE | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042550015 | ||||||||
| FaxNumber: | 4048453080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2009 | ||||||||
| LastUpdateDate: | 10/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | HOLDEN | ||||||||
| AuthorizedOfficialFirstName: | ALICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4049430205 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
No ID Information.