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PRIMARY CARE PEDIATRICS P.C. NPI 1578742516


NPI Information

NPI: 1578742516
Provider Name: PRIMARY CARE PEDIATRICS, P.C.
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 11D1073775

Address:
763 PEACHTREE PKWY STE 2
CUMMING, GA
ZIP 30041
Phone: (678) 208-2050
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PRIMARY CARE PEDIATRICS, P.C. is a primary care clinic center in Cumming, GA. PRIMARY CARE PEDIATRICS, P.C. NPI is 1578742516. The provider is registered as an organization entity type.

The provider's business location address is:

763 PEACHTREE PKWY STE 2
CUMMING, GA
ZIP 30041-351
Phone: (678) 208-2050
Fax: (678) 208-2051

The provider's authorized official is Jerome Charles Boudreaux .
The authorized official title is Cfo and has the following contact phone number (678) 208-2049.

The CLIA number assigned to this NPI record is 11D1073775 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/26/2007 and was last updated on 10/26/2007.


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 CareYes

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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