MEDICARE: ADVANCED CARE PEDIATRICS, INC.

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	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1396051355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CARE PEDIATRICS, INC.

Provider Business Mailing Address
First Line	:	55 IVAN ALLEN JR BLVD NW
Second Line	:	SUITE 525
City	:	ATLANTA
State	:	GA
Zip	:	30308-3050
Country	:	US
Telephone Number	:	404-835-3512
Fax Number	:	404-521-4444

Provider Business Practice Location Address
First Line	:	55 IVAN ALLEN JR BLVD NW
Second Line	:	SUITE 525
City	:	ATLANTA
State	:	GA
Zip	:	30308-3050
Country	:	US
Telephone Number	:	404-835-3512
Fax Number	:	404-521-4444

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHRISTOPHER D GOODWIN
Credential	:
Telephone Number	:	404-431-8931

Provider Enumeration Date	:	08/27/2010
Last Update Date	:	04/11/2011

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