MEDICARE: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C.

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
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1184763062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C.

Provider Business Mailing Address
First Line	:	10700 MEDLOCK BRIDGE RD
Second Line	:	STE 104
City	:	DULUTH
State	:	GA
Zip	:	30097-8456
Country	:	US
Telephone Number	:	770-476-9885
Fax Number	:	770-476-8482

Provider Business Practice Location Address
First Line	:	10700 MEDLOCK BRIDGE RD
Second Line	:	STE 104
City	:	DULUTH
State	:	GA
Zip	:	30097-8456
Country	:	US
Telephone Number	:	770-476-9885
Fax Number	:	770-476-8482

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JIMMY BROWN
Credential	:	M.D.
Telephone Number	:	770-476-9885

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	08/22/2020

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