MEDICARE: ABC PEDIATRIC GROUP, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1093729089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC PEDIATRIC GROUP, P.C.

Provider Business Mailing Address
First Line	:	2240 W PARK PLACE BLVD
Second Line	:
City	:	STONE MTN
State	:	GA
Zip	:	30087-3543
Country	:	US
Telephone Number	:	770-771-5222
Fax Number	:	770-771-5223

Provider Business Practice Location Address
First Line	:	2240 W PARK PLACE BLVD
Second Line	:	STE A
City	:	STONE MTN
State	:	GA
Zip	:	30087-3543
Country	:	US
Telephone Number	:	770-771-5222
Fax Number	:	770-771-5223

Authorized Official
Title or Position	:	PARTNER
Name	:	MARCIA A CUMBERBATCH
Credential	:	M.D.
Telephone Number	:	770-771-5222

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	09/25/2007

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