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General NPI Number Information
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NPI Number | 1871027839
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Entity Type | Organization
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Legal Business Name | BRIARVISTA PEDIATRICS
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 2244 HENDERSON MILL RD NE SUITE G
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City | ATLANTA
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State | GA
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Zip | 30345-2760
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Country | US
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Telephone | 770-239-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 1856 BERKELEY MEWS NE
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City | ATLANTA
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State | GA
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Zip | 30329-3361
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Country | US
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Telephone | 646-549-0000
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | EVE OSTER WEXLER
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Credential | MD
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Telephone | 646-549-0000
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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 | 71300
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License Number State | GA
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