Provider Demographics
NPI:1336457597
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:OWNER/HEAD NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAHILL-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:770-732-6007
Mailing Address - Street 1:393 MAXHAM RD
Mailing Address - Street 2:STE. 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 1:275 CARPENTER DR NE
Practice Address - Street 2:SUITE 201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4928
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:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty