Provider Demographics
NPI:1134297799
Name:SUGARLOAF PEDIATRICS, PC
Entity Type:Organization
Organization Name:SUGARLOAF PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-377-1113
Mailing Address - Street 1:3525 SUGARLOAF PKWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5403
Mailing Address - Country:US
Mailing Address - Phone:678-377-1113
Mailing Address - Fax:678-377-9390
Practice Address - Street 1:3525 SUGARLOAF PKWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5403
Practice Address - Country:US
Practice Address - Phone:678-377-1113
Practice Address - Fax:678-377-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care