MEDICARE: JOHNS CREEK PEDIATRICS

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	031098	GA

General Provider Information

NPI Number	:	1215177753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNS CREEK PEDIATRICS

Provider Business Mailing Address
First Line	:	4395 JOHNS CREEK PKWY
Second Line	:	SUITE 150
City	:	SUWANEE
State	:	GA
Zip	:	30024-6048
Country	:	US
Telephone Number	:	770-814-1160
Fax Number	:	770-814-1173

Provider Business Practice Location Address
First Line	:	4395 JOHNS CREEK PKWY
Second Line	:	SUITE 150
City	:	SUWANEE
State	:	GA
Zip	:	30024-6048
Country	:	US
Telephone Number	:	770-814-1160
Fax Number	:	770-814-1173

Authorized Official
Title or Position	:	PEDIATRICIAN
Name	:	DR. HARRIETTE S PERLSTEIN
Credential	:	MD
Telephone Number	:	770-814-1160

Provider Enumeration Date	:	02/24/2009
Last Update Date	:	02/24/2009

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