Provider Demographics
NPI:1346738457
Name:ALLIANCE PEDIATRIC PROVIDERS, LLC
Entity Type:Organization
Organization Name:ALLIANCE PEDIATRIC PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:PITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-280-5190
Mailing Address - Street 1:1512 ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5047
Mailing Address - Country:US
Mailing Address - Phone:770-280-5190
Mailing Address - Fax:470-300-3550
Practice Address - Street 1:1512 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5047
Practice Address - Country:US
Practice Address - Phone:770-280-5190
Practice Address - Fax:470-300-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075-R-1954251J00000X, 253Z00000X, 376K00000X, 163WA2000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Yes251J00000XAgenciesNursing CareGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty