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General NPI Number Information
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NPI Number | 1417044181
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Entity Type | Organization
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Legal Business Name | KIDCARE PEDIATRICS
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 910 DANNON VW SW STE 2101
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City | ATLANTA
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State | GA
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Zip | 30331-2156
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Country | US
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Telephone | 404-691-6100
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Fax | 404-691-6959
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Provider Business Mailing Address
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Address Line | 910 DANNON VW SW STE 2101
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City | ATLANTA
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State | GA
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Zip | 30331-2156
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Country | US
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Telephone | 404-691-6100
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Fax | 404-691-6959
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Authorized Official
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Title or Position | CEO
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Name | MR. CHAUNCEY DANIELS
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Credential |
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Telephone | 404-765-9437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 057447
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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