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General NPI Number Information
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NPI Number | 1003119934
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Entity Type | Organization
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Legal Business Name | UNITED PEDIATRICS PC
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 4775 JIMMY CARTER BLVD SUITE 102
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City | NORCROSS
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State | GA
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Zip | 30093-3760
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Country | US
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Telephone | 770-717-0033
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Fax | 770-717-0028
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Provider Business Mailing Address
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Address Line | 4775 JIMMY CARTER BLVD SUITE 102
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City | NORCROSS
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State | GA
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Zip | 30093-3760
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Country | US
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Telephone | 770-717-0033
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Fax | 770-717-0028
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Authorized Official
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Title or Position | OWNER
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Name | DR. TAYABA FATEMA
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Credential | MD
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Telephone | 770-717-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 045783
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License Number State | GA
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