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General NPI Number Information
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NPI Number | 1467710715
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Entity Type | Organization
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Legal Business Name | NORCROSS PEDIATRICS AND ADOLESCENT MEDICINE, INC
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 1235 INDIAN TRAIL RD SUITE 106
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City | NORCROSS
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State | GA
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Zip | 30093-4502
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Country | US
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Telephone | 770-923-6400
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Fax | 770-564-1697
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Provider Business Mailing Address
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Address Line | PO BOX 4048
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City | MACON
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State | GA
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Zip | 31208-4048
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Country | US
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Telephone | 770-923-6400
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Fax | 770-564-1697
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Authorized Official
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Title or Position | OWNER
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Name | GEORGE KATSITADZE
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Credential | MD
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Telephone | 770-923-6400
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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 |
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License Number State |
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