Healthcare Provider Details

I. General information

NPI: 1336457597
Provider Name (Legal Business Name): NUESTROS NINOS OUR KIDS PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CARPENTER DR NE SUITE 201
ATLANTA GA
30328-4928
US

IV. Provider business mailing address

393 MAXHAM RD STE. A&B
AUSTELL GA
30168-5539
US

V. Phone/Fax

Practice location:
  • Phone: 770-732-6007
  • Fax: 770-732-8242
Mailing address:
  • Phone: 770-732-6007
  • Fax: 770-732-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARY E. CAHILL-ROBERTS
Title or Position: OWNER/HEAD NURSE PRACTITIONER
Credential: CPNP
Phone: 770-732-6007