MOUNTAINSIDE PEDIATRICS NPI 1710267505

NPI Information

NPI: 1710267505
Provider Name: MOUNTAINSIDE PEDIATRICS
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 11D0969638

Address:
12 SAMMY MCGHEE BLVD
SUITE 102
JASPER, GA
ZIP 30143
Phone: (706) 253-9898
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MOUNTAINSIDE PEDIATRICS is a primary care clinic center in Jasper, GA. MOUNTAINSIDE PEDIATRICS NPI is 1710267505. The provider is registered as an organization entity type.

The provider's business location address is:

12 SAMMY MCGHEE BLVD
SUITE 102
JASPER, GA
ZIP 30143-711
Phone: (706) 253-9898
Fax: (706) 253-9896

The provider's authorized official is Khawaja Raza Mahmood .
The authorized official title is Sole Proprietor and has the following contact phone number (706) 253-9898.

The CLIA number assigned to this NPI record is 11D0969638 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/24/2011 and was last updated on 8/24/2011.

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	261QP2300X	Clinic/Center	Primary Care	42648	GEORGIA	Yes

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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