MEDICARE: PEDIATRICS IN MOTION GA

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	103TB0200X	Cognitive & Behavioral Psychologist

General Provider Information

NPI Number	:	1639023781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRICS IN MOTION GA

Provider Business Mailing Address
First Line	:	2721 HIGHWAY 138 E
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30236-2745
Country	:	US
Telephone Number	:	470-615-7906
Fax Number	:

Provider Business Practice Location Address
First Line	:	2721 HIGHWAY 138 E
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30236-2745
Country	:	US
Telephone Number	:	470-615-7906
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TABETHA SMITH
Credential	:
Telephone Number	:	470-615-7906

Provider Enumeration Date	:	02/25/2026
Last Update Date	:	02/25/2026

Similar Medicare Providers

1417801689 — TABETHA SMITH
Practice Location Address:

2721 HIGHWAY 138 E
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1922950443 — BRIANNA KITCHENS M.S., CCC-SLP
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