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NPI Code Detail

MEDICARE: PEDIATRIC SERVICES OF AMERICA, LLC

MEDICARE: PEDIATRIC SERVICES OF AMERICA, 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
1251E00000XHome Health Agency
2385H00000XRespite Care
3251J00000XNursing Care Agency

Other Identifiers

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

General Provider Information

NPI Number : 1730101171
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC SERVICES OF AMERICA, LLC
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 : 770-248-8192
Provider Business Practice Location Address
First Line : 6330 N CENTER DR
Second Line : RAPPAHANNOCK BLDG # 13, STE 142
City : NORFOLK
State : VA
Zip : 23502-4008
Country : US
Telephone Number : 757-461-6310
Fax Number : 757-461-6317
Authorized Official
Title or Position : CFO
Name : MATTHEW BUCKHALTER
Credential :
Telephone Number : 470-464-8000
Provider Enumeration Date : 07/24/2006
Last Update Date : 01/27/2025

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Directions to “PEDIATRIC SERVICES OF AMERICA, LLC ” Practice Location

Language Start Address Practice Location
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