Provider Demographics
NPI:1427214642
Name:TEENS, LITTLE ONES AND CHILDREN PEDIATRICS LLC
Entity Type:Organization
Organization Name:TEENS, LITTLE ONES AND CHILDREN PEDIATRICS LLC
Other - Org Name:TLC PEDIATRICS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LATRECE
Authorized Official - Last Name:GRIMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-691-4321
Mailing Address - Street 1:2600 MARTIN LUTHER KING JR DR SW
Mailing Address - Street 2:STE 206
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-1636
Mailing Address - Country:US
Mailing Address - Phone:404-691-4321
Mailing Address - Fax:404-691-4304
Practice Address - Street 1:2600 MARTIN LUTHER KING JR DR SW
Practice Address - Street 2:STE 206
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-1636
Practice Address - Country:US
Practice Address - Phone:404-691-4321
Practice Address - Fax:404-691-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA85002281GMedicaid