Healthcare Provider Details

I. General information

NPI: 1497865935
Provider Name (Legal Business Name): CHILDFREN'S MEDICAL GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 CENTURY BLVD NE SUITE 150
ATLANTA GA
30345-3319
US

IV. Provider business mailing address

1875 CENTURY BLVD NE SUITE 150
ATLANTA GA
30345-3319
US

V. Phone/Fax

Practice location:
  • Phone: 404-633-4595
  • Fax: 404-633-6711
Mailing address:
  • Phone: 404-633-4595
  • Fax: 404-633-6711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM K JANN
Title or Position: PRESIDENT
Credential: MD
Phone: 404-633-4595