Healthcare Provider Details

I. General information

NPI: 1205819737
Provider Name (Legal Business Name): NUESTROS NINOS OUR KIDS PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

393 MAXHAM RD SUITES 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 TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN083997
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN170709
License Number StateGA

VIII. Authorized Official

Name: MARY ELIZABETH CAHILL
Title or Position: OWNERCEO
Credential: CPNP
Phone: 770-732-6007