Healthcare Provider Details

I. General information

NPI: 1710003520
Provider Name (Legal Business Name): PIEDMONT PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COLLIER RD NW SUITE 4060
ATLANTA GA
30309-1710
US

IV. Provider business mailing address

105 COLLIER RD NW SUITE 4060
ATLANTA GA
30309-1710
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-6662
  • Fax: 404-351-6030
Mailing address:
  • Phone: 404-351-6662
  • Fax: 404-351-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RICHARD L WEIL
Title or Position: PARTNER
Credential: MD
Phone: 404-351-6662