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General NPI Number Information
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NPI Number | 1952888927
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Entity Type | Organization
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Legal Business Name | TOTAL ACCESS PEDIATRICS LLC
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Dates
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Enumeration Date | 07/23/2018
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 401 S MAIN ST STE A1
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City | ALPHARETTA
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State | GA
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Zip | 30009
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Country | US
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Telephone | 470-300-9009
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Fax | 404-393-3912
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Provider Business Mailing Address
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Address Line | 4470 CHAMBLEE DUNWOODY RD STE 510
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City | DUNWOODY
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State | GA
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Zip | 30338-6238
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SYDNEY NICHOLS
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Credential | MD
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Telephone | 620-515-2487
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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 | 077296
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License Number State | GA
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