Provider Demographics
NPI:1386041457
Name:PREMIER PEDIATRICS ASSOCIATES
Entity Type:Organization
Organization Name:PREMIER PEDIATRICS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFINI
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLINGSLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-235-4926
Mailing Address - Street 1:3200 HIGHLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082
Mailing Address - Country:US
Mailing Address - Phone:770-235-4926
Mailing Address - Fax:888-749-4745
Practice Address - Street 1:3200 HIGHLANDS PKWY SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5166
Practice Address - Country:US
Practice Address - Phone:770-235-4926
Practice Address - Fax:888-749-4745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66257208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty