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General NPI Number Information
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NPI Number | 1609036532
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ORTHOPAEDIC ASSOCIATES
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 6 EXECUTIVE PARK DR NE SUITE 10
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City | ATLANTA
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State | GA
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Zip | 30329-2221
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Country | US
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Telephone | 404-321-9900
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Fax | 404-321-4460
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Provider Business Mailing Address
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Address Line | 6 EXECUTIVE PARK DR NE SUITE 10
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City | ATLANTA
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State | GA
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Zip | 30329-2221
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Country | US
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Telephone | 404-321-9900
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Fax | 404-321-4460
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Authorized Official
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Title or Position | CEO
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Name | MRS. MICHELLE GULLEY
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Credential |
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Telephone | 404-321-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 00010591
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License Number State | GA
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