Provider Demographics
NPI:1407922800
Name:PEDIATRIA HEALTHCARE LLC
Entity Type:Organization
Organization Name:PEDIATRIA HEALTHCARE LLC
Other - Org Name:PEDIATRIA HEALTHCARE FOR KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF BUSINESS OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:HOOKE
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-840-1966
Mailing Address - Street 1:5185 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-6542
Mailing Address - Country:US
Mailing Address - Phone:770-840-1966
Mailing Address - Fax:770-840-1901
Practice Address - Street 1:5185 PEACHTREE PKWY
Practice Address - Street 2:SUITE 350
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-6542
Practice Address - Country:US
Practice Address - Phone:770-840-1966
Practice Address - Fax:770-840-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-R-0244251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care