Healthcare Provider Details

I. General information

NPI: 1851444632
Provider Name (Legal Business Name): PEDIATRIC MEDICINE OF CARTERSVILLE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 COLLINS DR SUITE B
CARTERSVILLE GA
30120-2486
US

IV. Provider business mailing address

20 COLLINS DR SUITE B
CARTERSVILLE GA
30120-2486
US

V. Phone/Fax

Practice location:
  • Phone: 770-607-0795
  • Fax: 770-607-1339
Mailing address:
  • Phone: 770-607-0795
  • Fax: 770-607-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN120899
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN089950
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042415
License Number StateGA

VIII. Authorized Official

Name: DR. THOMAS D RYAN
Title or Position: CEO
Credential: M.D.
Phone: 770-607-0795