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NPI Code Detail

MEDICARE: SUGARLOAF PEDIATRICS, PC

MEDICARE: SUGARLOAF PEDIATRICS, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1134297799
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUGARLOAF PEDIATRICS, PC
Provider Business Mailing Address
First Line : 3525 SUGARLOAF PKWY
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-5403
Country : US
Telephone Number : 678-377-1113
Fax Number : 678-377-9390
Provider Business Practice Location Address
First Line : 3525 SUGARLOAF PKWY
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-5403
Country : US
Telephone Number : 678-377-1113
Fax Number : 678-377-9390
Authorized Official
Title or Position : OFFICE MANAGER
Name : MATHEN MATHEW
Credential :
Telephone Number : 678-377-1113
Provider Enumeration Date : 12/01/2006
Last Update Date : 08/22/2020

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