Healthcare Provider Details

I. General information

NPI: 1477029759
Provider Name (Legal Business Name): IMAGINE PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 RIVERBEND DR SW STE 210
ROME GA
30161-6019
US

IV. Provider business mailing address

18 RIVERBEND DR SW STE 210
ROME GA
30161-6019
US

V. Phone/Fax

Practice location:
  • Phone: 334-291-8360
  • Fax: 888-506-0507
Mailing address:
  • Phone: 706-528-4949
  • Fax: 706-204-8274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERICA PAEZ-ZAPATA
Title or Position: PRESIDENT
Credential: MD
Phone: 706-528-4949