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Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

PROVIDENCE PEDIATRICS, LLC

Active Organization

PROVIDENCE PEDIATRICS, LLC is a Primary Care Clinic organization located in TUCKER, Georgia. NPI 1104086800 is currently active in the NPPES registry. Verify at CMS.

Primary Care Clinic · TUCKER, GA

Registration Details

NPI Number
1104086800
Provider Type
Organization
NPI Issued
Jun 16, 2008 (18.178400034828 yrs)
Last Updated
Nov 4, 2010
License
041796 (GA)

Practice Information

Address
2171 NORTHLAKE PKWY
SUITE 114
TUCKER, GA, 300844104
Browse GA providers · Browse ZIP 30084
Phone
7709397477
Fax
7709397750
Primary Specialty
Primary Care Clinic
261QP2300X
Data sourced from the NPPES National Provider Identifier registry. Healthcare organizations registered in NPPES are assigned an NPI number for use in insurance billing and claims. This information is for informational purposes only. For official verification, use the NPPES NPI Registry.