Provider Demographics
NPI:1174837298
Name:GREEN WILLOW PEDIATRICS
Entity Type:Organization
Organization Name:GREEN WILLOW PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHT-NADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAP
Authorized Official - Phone:678-450-0747
Mailing Address - Street 1:3030 MCEVER RD
Mailing Address - Street 2:BUILDING 1, SUITE 130
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-5579
Mailing Address - Country:US
Mailing Address - Phone:678-450-0747
Mailing Address - Fax:678-450-0779
Practice Address - Street 1:3030 MCEVER RD
Practice Address - Street 2:BUILDING 1, SUITE 130
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-5579
Practice Address - Country:US
Practice Address - Phone:678-450-0747
Practice Address - Fax:678-450-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046361208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty