Healthcare Provider Details

I. General information

NPI: 1083820765
Provider Name (Legal Business Name): SANDY SPRINGS PEDIATRICS AND ADOLESCENT MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 JOHNSON FERRY RD NE # F STE 370
ATLANTA GA
30342-1620
US

IV. Provider business mailing address

993 JOHNSON FERRY RD NE # F STE 370
ATLANTA GA
30342-1620
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-4611
  • Fax: 404-256-1759
Mailing address:
  • Phone: 404-252-4611
  • Fax: 404-256-1759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTY LOCKERT
Title or Position: OFFICE MANAGER
Credential:
Phone: 404-252-4611