Healthcare Provider Details

I. General information

NPI: 1679789333
Provider Name (Legal Business Name): PEDIATRIC INFECTIOUS DISEASE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LAKE HEARN DR NE STE 275
SANDY SPRINGS GA
30319-1411
US

IV. Provider business mailing address

1200 LAKE HEARN DR NE STE 275
SANDY SPRINGS GA
30319-1411
US

V. Phone/Fax

Practice location:
  • Phone: 470-993-6287
  • Fax: 470-961-7300
Mailing address:
  • Phone: 470-993-6287
  • Fax: 470-961-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTY LOCKERT
Title or Position: OFFICE MANAGER
Credential:
Phone: 404-252-4611