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General NPI Number Information
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NPI Number | 1598383754
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Entity Type | Organization
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Legal Business Name | NORCROSS PEDIATRIC AND FAMILY MEDICINE CORPORATION
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 4608 JIMMY CARTER BLVD STE 7
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City | NORCROSS
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State | GA
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Zip | 30093-3758
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Country | US
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Telephone | 770-938-6966
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Fax | 770-938-6968
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Provider Business Mailing Address
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Address Line | 4608 JIMMY CARTER BLVD STE 7
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City | NORCROSS
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State | GA
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Zip | 30093-3758
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | GERMAINE LANGIRA
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Credential |
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Telephone | 770-771-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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