Provider Demographics
NPI:1083820765
Name:SANDY SPRINGS PEDIATRICS AND ADOLESCENT MEDICINE
Entity Type:Organization
Organization Name:SANDY SPRINGS PEDIATRICS AND ADOLESCENT MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-252-4611
Mailing Address - Street 1:993 JOHNSON FERRY RD NE # F
Mailing Address - Street 2:STE 370
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1620
Mailing Address - Country:US
Mailing Address - Phone:404-252-4611
Mailing Address - Fax:404-256-1759
Practice Address - Street 1:993 JOHNSON FERRY RD NE # F
Practice Address - Street 2:STE 370
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1620
Practice Address - Country:US
Practice Address - Phone:404-252-4611
Practice Address - Fax:404-256-1759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty