Provider Demographics
NPI:1467710715
Name:NORCROSS PEDIATRICS AND ADOLESCENT MEDICINE, INC
Entity Type:Organization
Organization Name:NORCROSS PEDIATRICS AND ADOLESCENT MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KATSITADZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-923-6400
Mailing Address - Street 1:PO BOX 4048
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4048
Mailing Address - Country:US
Mailing Address - Phone:770-923-6400
Mailing Address - Fax:770-564-1697
Practice Address - Street 1:1235 INDIAN TRAIL RD
Practice Address - Street 2:SUITE 106
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-4502
Practice Address - Country:US
Practice Address - Phone:770-923-6400
Practice Address - Fax:770-564-1697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty