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General NPI Number Information
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NPI Number | 1710280268
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Entity Type | Organization
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Legal Business Name | PEDIATRIA HEALTHCARE FOR KIDS
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 12/06/2010
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Provider Practice Location Address
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Address Line | 5185 PEACHTREE PKWY SUITE 350
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City | NORCROSS
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State | GA
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Zip | 30092-6542
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Country | US
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Telephone | 770-840-1966
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Fax |
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Provider Business Mailing Address
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Address Line | 5185 PEACHTREE PKWY SUITE 350
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City | NORCROSS
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State | GA
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Zip | 30092-6542
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Country | US
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Telephone | 770-840-1966
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Fax |
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Authorized Official
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Title or Position | SENIOR VP
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Name | MRS. NANCY COFFIELD
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Credential | RN
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Telephone | 770-840-1966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | RN151537
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License Number State | GA
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