Healthcare Provider Details

I. General information

NPI: 1821355447
Provider Name (Legal Business Name): JUST US KIDS PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2462 HIGHWAY 34 EAST SUITE A
NEWNAN GA
30265
US

IV. Provider business mailing address

2462 HIGHWAY 34 EAST SUITE A
NEWNAN GA
30265
US

V. Phone/Fax

Practice location:
  • Phone: 770-683-5437
  • Fax: 770-683-3758
Mailing address:
  • Phone: 770-683-5437
  • Fax: 770-683-3758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number47777
License Number StateGA

VIII. Authorized Official

Name: DR. REGINA JUSTICE
Title or Position: CEO/OWNER
Credential: M.D.
Phone: 678-491-7657