Provider Demographics
NPI:1396188876
Name:EAST METRO PRIMARY CARE
Entity Type:Organization
Organization Name:EAST METRO PRIMARY CARE
Other - Org Name:EAST ATLANTA PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:AFROZ
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-935-1515
Mailing Address - Street 1:325 LESTER RD NW
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4024
Mailing Address - Country:US
Mailing Address - Phone:770-935-1515
Mailing Address - Fax:770-935-1040
Practice Address - Street 1:325 LESTER RD NW
Practice Address - Street 2:SUITE C
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-4024
Practice Address - Country:US
Practice Address - Phone:770-935-1515
Practice Address - Fax:770-935-1040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST METRO PRIMARY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017940174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10039791Medicaid
GA317911Medicaid
GA317912Medicaid
GA317911Medicaid