THE PEDIATRIC OFFICE LLC NPI 1629025432

NPI Information

NPI: 1629025432
Provider Name: THE PEDIATRIC OFFICE, LLC
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

Address:
4321 UNIVERSITY PKWY
SUITE 104
EVANS, GA
ZIP 30809
Phone: (706) 854-2600
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THE PEDIATRIC OFFICE, LLC is an adolescent medicine pediatrics in Evans, GA. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. THE PEDIATRIC OFFICE, LLC NPI is 1629025432. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4321 UNIVERSITY PKWY
SUITE 104
EVANS, GA
ZIP 30809-058
Phone: (706) 854-2600
Fax: (706) 854-2601

The provider's authorized official is Keelyn Clark Cunningham .
The authorized official title is Office Manager and has the following contact phone number (706) 854-2600.

The enumeration date for this NPI number is 5/27/2006 and was last updated on 11/5/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080A0000X	Pediatrics	Adolescent Medicine			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	300035984A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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