Provider Demographics
NPI: | 1225417058 |
---|---|
Name: | ONE FAMILY PEDIATRICS, LLC |
Entity Type: | Organization |
Organization Name: | ONE FAMILY PEDIATRICS, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNDER/PEDIATRICIAN |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | HIRAL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LAVANIA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 678-962-7337 |
Mailing Address - Street 1: | 2575 PEACHTREE PKWY |
Mailing Address - Street 2: | SUITE 301 |
Mailing Address - City: | CUMMING |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30041-7559 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2575 PEACHTREE PKWY |
Practice Address - Street 2: | SUITE 301 |
Practice Address - City: | CUMMING |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30041-7559 |
Practice Address - Country: | US |
Practice Address - Phone: | 678-962-7337 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-05-26 |
Last Update Date: | 2015-05-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | 062412 | 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Single Specialty |