Healthcare Provider Details

I. General information

NPI: 1346738457
Provider Name (Legal Business Name): ALLIANCE PEDIATRIC PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 08/25/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WESTRIDGE INDUSTRIAL BLVD STE 380
MCDONOUGH GA
30253-4214
US

IV. Provider business mailing address

115 WESTRIDGE INDUSTRIAL BLVD STE 380
MCDONOUGH GA
30253-4214
US

V. Phone/Fax

Practice location:
  • Phone: 770-389-1525
  • Fax: 470-300-3550
Mailing address:
  • Phone: 770-389-1525
  • Fax: 470-300-3550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number075-R-1954
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number075-R-1954
License Number StateGA

VIII. Authorized Official

Name: MRS. KAREN LYNNE PITMAN
Title or Position: RN, DIRECTOR OF OPERATIONS
Credential: RN
Phone: 770-389-1525