Provider Demographics
NPI:1285859413
Name:TRI-COUNTY PEDIATRICS
Entity Type:Organization
Organization Name:TRI-COUNTY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PURNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHADALAWADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-996-9191
Mailing Address - Street 1:808 COMMERCE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-7192
Mailing Address - Country:US
Mailing Address - Phone:770-996-9191
Mailing Address - Fax:
Practice Address - Street 1:808 COMMERCE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-7192
Practice Address - Country:US
Practice Address - Phone:770-996-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty