Healthcare Provider Details

I. General information

NPI: 1922588474
Provider Name (Legal Business Name): LITTLE FIVE POINTS PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 MORELAND AVE NE STE 400
ATLANTA GA
30307-1500
US

IV. Provider business mailing address

427 MORELAND AVE NE STE 400
ATLANTA GA
30307-1500
US

V. Phone/Fax

Practice location:
  • Phone: 404-521-2445
  • Fax: 404-521-0067
Mailing address:
  • Phone: 404-521-2445
  • Fax: 404-521-0067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number052763
License Number StateGA

VIII. Authorized Official

Name: DR. SHELLEY ELIZABETH KIM
Title or Position: OWNER/PEDIATRICIAN
Credential: MD
Phone: 404-521-2445