Provider Demographics
NPI:1043480247
Name:TENDERCARE PEDIATRICS
Entity Type:Organization
Organization Name:TENDERCARE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRAELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE-FORTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-297-0070
Mailing Address - Street 1:5755 N POINT PKWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1142
Mailing Address - Country:US
Mailing Address - Phone:678-297-0070
Mailing Address - Fax:678-297-0073
Practice Address - Street 1:5755 N POINT PKWY
Practice Address - Street 2:SUITE 215
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1142
Practice Address - Country:US
Practice Address - Phone:678-297-0070
Practice Address - Fax:678-297-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041106208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF41642Medicare UPIN