Provider Demographics
NPI:1205819737
Name:NUESTROS NINOS OUR KIDS PEDIATRICS PC
Entity Type:Organization
Organization Name:NUESTROS NINOS OUR KIDS PEDIATRICS PC
Other - Org Name:NUESTROS NINOS Y LA FAMILIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNERCEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:770-732-6007
Mailing Address - Street 1:393 MAXHAM RD
Mailing Address - Street 2:SUITES A&B
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-5539
Mailing Address - Country:US
Mailing Address - Phone:770-732-6007
Mailing Address - Fax:770-732-8242
Practice Address - Street 1:393 MAXHAM RD
Practice Address - Street 2:SUITES A&B
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-5539
Practice Address - Country:US
Practice Address - Phone:770-732-6007
Practice Address - Fax:770-732-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170709363LF0000X
GARN083997363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty