Healthcare Provider Details

I. General information

NPI: 1851494447
Provider Name (Legal Business Name): CRESCENT PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 PREMIERE PKWY SUITE 140
DULUTH GA
30097
US

IV. Provider business mailing address

2925 PREMIERE PKWY SUITE 140
DULUTH GA
30097
US

V. Phone/Fax

Practice location:
  • Phone: 770-495-6222
  • Fax: 770-495-9959
Mailing address:
  • Phone: 770-495-6222
  • Fax: 770-495-9959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number034204
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number034204
License Number StateGA

VIII. Authorized Official

Name: DR. WILLIAM MONEIT
Title or Position: PRESIDENT
Credential: MD
Phone: 770-495-6222