Provider Demographics
NPI:1326269598
Name:KIDS FIRST PEDIATRICS OF GEORGIA, P.C.
Entity Type:Organization
Organization Name:KIDS FIRST PEDIATRICS OF GEORGIA, P.C.
Other - Org Name:POOLER PEDIATRICS, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-748-4527
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-0668
Mailing Address - Country:US
Mailing Address - Phone:912-748-4527
Mailing Address - Fax:912-748-9016
Practice Address - Street 1:143 CANAL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-6007
Practice Address - Country:US
Practice Address - Phone:912-748-4527
Practice Address - Fax:912-748-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000725381BMedicaid
GA1326048992OtherPEDIATRICS-DR FRANCISCO J. HERRAN
GA837258124CMedicaid
GA897572509AMedicaid
GA000835535BMedicaid
GA1144213018OtherPEDIATRICS-DR KAREN M. KIM
GA897572509BMedicaid
GA000839682DMedicaid
GA1811980741OtherPEDIATRICS-DR ROLANDO Z. MANALO
GA1831188259OtherPEDIATRICS-DR YOLANDA M. RIVERA-CAUDILL
GA000725381CMedicaid
GA920085272BMedicaid
GA000835535CMedicaid
GA897572509CMedicaid
GA000835535DMedicaid
GA837258124AMedicaid
GA000839682BMedicaid
GA920085272CMedicaid
GA1033307293OtherPEDIATRICS-DR KARA L. KENNEDY
GA1134193642OtherPEDIATRICS-DR RONALD G.JONES
GA837258124BMedicaid
GA920085272AMedicaid
GA000839682BMedicaid
GA000835535BMedicaid