Healthcare Provider Details

I. General information

NPI: 1972684660
Provider Name (Legal Business Name): CUMBERLAND PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 FRANKLIN RD SE
MARIETTA GA
30067-8705
US

IV. Provider business mailing address

1405 FRANKLIN RD SE
MARIETTA GA
30067-8705
US

V. Phone/Fax

Practice location:
  • Phone: 770-951-5400
  • Fax: 770-951-0955
Mailing address:
  • Phone: 770-951-5400
  • Fax: 770-951-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAREN A MOORE
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 770-951-5400