MEDICARE: TRI-COUNTY 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

General Provider Information

NPI Number	:	1285859413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-COUNTY PEDIATRICS

Provider Business Mailing Address
First Line	:	808 COMMERCE BLVD
Second Line	:	SUITE A
City	:	RIVERDALE
State	:	GA
Zip	:	30296-7192
Country	:	US
Telephone Number	:	770-996-9191
Fax Number	:

Provider Business Practice Location Address
First Line	:	808 COMMERCE BLVD
Second Line	:	SUITE A
City	:	RIVERDALE
State	:	GA
Zip	:	30296-7192
Country	:	US
Telephone Number	:	770-996-9191
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	MRS. PURNA CHADALAWADA
Credential	:	M.D.
Telephone Number	:	770-996-9191

Provider Enumeration Date	:	04/14/2007
Last Update Date	:	08/22/2020

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Directions to “TRI-COUNTY PEDIATRICS ” Practice Location

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