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General NPI Number Information
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NPI Number | 1881084879
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE AT CHILDRENS, LLC
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Dates
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Enumeration Date | 01/28/2015
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 1575 NORTHEAST EXPY NE
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City | BROOKHAVEN
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State | GA
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Zip | 30329-2401
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Country | US
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Telephone | 404-785-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 1575 NORTHEAST EXPY NE
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City | BROOKHAVEN
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State | GA
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Zip | 30329-2401
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Country | US
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Telephone | 404-785-7928
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | RUTH FOWLER
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Credential |
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Telephone | 404-785-5437
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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 |
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License Number State |
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