Basic Information
| Provider Information | |||||||||
| NPI: | 1902923964 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ABC PEDIATRICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 735 GLYNN ST S | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302142049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704614126 | ||||||||
| FaxNumber: | 7704618852 | ||||||||
| Practice Location | |||||||||
| Address1: | 735 GLYNN ST S | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302142049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704614126 | ||||||||
| FaxNumber: | 7704618852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FOSTER | ||||||||
| AuthorizedOfficialFirstName: | CAROLJANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7704614126 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.