Healthcare Provider Details

I. General information

NPI: 1083669063
Provider Name (Legal Business Name): NORTH FULTON PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 HEMBREE RD SUITE 100
ROSWELL GA
30076-5720
US

IV. Provider business mailing address

1285 HEMBREE RD SUITE 100
ROSWELL GA
30076-5720
US

V. Phone/Fax

Practice location:
  • Phone: 770-442-1050
  • Fax: 770-475-1621
Mailing address:
  • Phone: 770-442-1050
  • Fax: 770-475-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. LINDA G. RICKEY
Title or Position: PRACTICE ADMINISTRATOR
Credential: C.O.E.
Phone: 678-893-7550