Healthcare Provider Details

I. General information

NPI: 1407894165
Provider Name (Legal Business Name): PEDIATRIC FIRST, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 N HOUSTON RD
WARNER ROBINS GA
31093-1505
US

IV. Provider business mailing address

1049 N HOUSTON RD
WARNER ROBINS GA
31093-1505
US

V. Phone/Fax

Practice location:
  • Phone: 478-922-9001
  • Fax: 478-329-8619
Mailing address:
  • Phone: 478-922-9001
  • Fax: 478-329-8619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number015890
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number052204
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number042560
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number015890
License Number StateGA

VIII. Authorized Official

Name: SANTANU DAS
Title or Position: PHYSICIAN-OWNER
Credential: MD
Phone: 478-922-9001