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EAGLES LANDING PEDIATRIC ASSOCIATES LLC NPI 1740407550


NPI Information

NPI: 1740407550
Provider Name: EAGLES LANDING PEDIATRIC ASSOCIATES LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 11D0960900

Address:
1101 HOSPITAL DR
SUITE 210
STOCKBRIDGE, GA
ZIP 30281
Phone: (678) 289-0103
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EAGLES LANDING PEDIATRIC ASSOCIATES LLC is a primary care clinic center in Stockbridge, GA. EAGLES LANDING PEDIATRIC ASSOCIATES LLC NPI is 1740407550. The provider is registered as an organization entity type.

The provider's business location address is:

1101 HOSPITAL DR
SUITE 210
STOCKBRIDGE, GA
ZIP 30281-075
Phone: (678) 289-0103
Fax: (678) 289-0171

The provider's authorized official is Steven Wayne Leard .
The authorized official title is Ownerphysician and has the following contact phone number (678) 289-0103.

The CLIA number assigned to this NPI record is 11D0960900 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/20/2007 and was last updated on 8/22/2020.


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
1261QP2300XClinic/CenterPrimary Care040449GEORGIAYes

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

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