Provider Demographics
NPI:1215177753
Name:JOHNS CREEK PEDIATRICS
Entity Type:Organization
Organization Name:JOHNS CREEK PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRIETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PERLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-814-1160
Mailing Address - Street 1:4395 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6048
Mailing Address - Country:US
Mailing Address - Phone:770-814-1160
Mailing Address - Fax:770-814-1173
Practice Address - Street 1:4395 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6048
Practice Address - Country:US
Practice Address - Phone:770-814-1160
Practice Address - Fax:770-814-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031098208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty