Healthcare Provider Details

I. General information

NPI: 1669846390
Provider Name (Legal Business Name): CIMA PEDIATRICS CV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 CHAMBLEE TUCKER RD SUITE 1-7B
CHAMBLEE GA
30341-2754
US

IV. Provider business mailing address

1841 CHAMBLEE TUCKER RD SUITE 1-7B
CHAMBLEE GA
30341-2754
US

V. Phone/Fax

Practice location:
  • Phone: 678-894-4147
  • Fax: 678-722-8329
Mailing address:
  • Phone: 678-894-4147
  • Fax: 678-215-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number StateGA

VIII. Authorized Official

Name: MARCELA QUINTERO
Title or Position: BUSINESS MANAGER
Credential:
Phone: 404-250-4447