MEDICARE: MADE FOR MORE PEDIATRIC CLINIC LLC

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1366396731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADE FOR MORE PEDIATRIC CLINIC LLC

Provider Business Mailing Address
First Line	:	600 GRAND OAKS WAY UNIT 1411
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-0028
Country	:	US
Telephone Number	:	706-421-2194
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 GRAND OAKS WAY UNIT 1411
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-0028
Country	:	US
Telephone Number	:	706-421-2194
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MADDIE BURTON
Credential	:
Telephone Number	:	706-421-2194

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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