Provider Demographics
NPI:1093729089
Name:ABC PEDIATRIC GROUP, P.C.
Entity Type:Organization
Organization Name:ABC PEDIATRIC GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUMBERBATCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-771-5222
Mailing Address - Street 1:2240 W PARK PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:STONE MTN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3543
Mailing Address - Country:US
Mailing Address - Phone:770-771-5222
Mailing Address - Fax:770-771-5223
Practice Address - Street 1:2240 W PARK PLACE BLVD
Practice Address - Street 2:STE A
Practice Address - City:STONE MTN
Practice Address - State:GA
Practice Address - Zip Code:30087-3543
Practice Address - Country:US
Practice Address - Phone:770-771-5222
Practice Address - Fax:770-771-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty