Healthcare Provider Details

I. General information

NPI: 1134751068
Provider Name (Legal Business Name): TOTAL CARE PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2020
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3672 MARATHON CIR STE 140
AUSTELL GA
30106-6821
US

IV. Provider business mailing address

PO BOX 1339
MABLETON GA
30126-1005
US

V. Phone/Fax

Practice location:
  • Phone: 470-502-0202
  • Fax: 470-582-9386
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MELVIN G PERRY
Title or Position: OWNER
Credential: MD
Phone: 470-502-0202