Healthcare Provider Details

I. General information

NPI: 1316873938
Provider Name (Legal Business Name): CHILDREN'S MEDICAL CENTRAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 EASTVIEW PKWY STE 100
CONYERS GA
30013-5771
US

IV. Provider business mailing address

2135 EASTVIEW PKWY STE 100
CONYERS GA
30013-5771
US

V. Phone/Fax

Practice location:
  • Phone: 770-918-8099
  • Fax: 770-918-8402
Mailing address:
  • Phone: 770-918-8099
  • Fax: 770-918-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY CARR
Title or Position: OWNER
Credential: MD
Phone: 770-918-8099