Healthcare Provider Details

I. General information

NPI: 1689840852
Provider Name (Legal Business Name): CHILDRENS CARE PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 MERIDIAN MARK RD STE 380
SANDY SPRINGS GA
30342-4755
US

IV. Provider business mailing address

5445 MERIDIAN MARK RD STE 380
SANDY SPRINGS GA
30342-4755
US

V. Phone/Fax

Practice location:
  • Phone: 404-705-3100
  • Fax: 404-705-3040
Mailing address:
  • Phone: 404-705-3100
  • Fax: 404-705-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number034258
License Number StateGA

VIII. Authorized Official

Name: MRS. TIANA JAMES
Title or Position: OFFICE MANAGER
Credential:
Phone: 404-705-3100