=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821355447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUST US KIDS PEDIATRICS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2012
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2462 HIGHWAY 34 EAST SUITE A
-----------------------------------------------------
City | NEWNAN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-683-5437
-----------------------------------------------------
Fax | 770-683-3758
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2462 HIGHWAY 34 EAST SUITE A
-----------------------------------------------------
City | NEWNAN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-683-5437
-----------------------------------------------------
Fax | 770-683-3758
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | DR. REGINA JUSTICE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 678-491-7657
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 47777
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------