MEDICARE: THE PEDIATRIC CONNECTION, 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	251E00000X	Home Health Agency
2	163WP0200X	Pediatric Registered Nurse	497431	VA
3	163WP0200X	Pediatric Registered Nurse
4	251J00000X	Nursing Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619092087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PEDIATRIC CONNECTION, INC

Provider Business Mailing Address
First Line	:	400 INTERSTATE NORTH PKWY SE STE 1600
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-5047
Country	:	US
Telephone Number	:	470-464-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 N CENTRAL AVE STE 140
Second Line	:
City	:	STAUNTON
State	:	VA
Zip	:	24401-4212
Country	:	US
Telephone Number	:	804-675-4550
Fax Number	:	434-227-5703

Authorized Official
Title or Position	:	CFO
Name	:	MATTHEW BUCKHALTER
Credential	:
Telephone Number	:	470-464-8000

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	03/06/2026

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Directions to “THE PEDIATRIC CONNECTION, INC ” Practice Location

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