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General NPI Number Information
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NPI Number | 1851444632
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Entity Type | Organization
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Legal Business Name | PEDIATRIC MEDICINE OF CARTERSVILLE, P.C.
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 20 COLLINS DR SUITE B
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City | CARTERSVILLE
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State | GA
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Zip | 30120-2486
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Country | US
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Telephone | 770-607-0795
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Fax | 770-607-1339
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Provider Business Mailing Address
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Address Line | 20 COLLINS DR SUITE B
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City | CARTERSVILLE
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State | GA
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Zip | 30120-2486
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Country | US
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Telephone | 770-607-0795
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Fax | 770-607-1339
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Authorized Official
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Title or Position | CEO
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Name | DR. THOMAS D RYAN
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Credential | M.D.
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Telephone | 770-607-0795
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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 | 042415
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN089950
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN120899
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License Number State | GA
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