Provider Demographics
NPI:1497513923
Name:NORTHWEST PEDIATRIC CARE
Entity Type:Organization
Organization Name:NORTHWEST PEDIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CORA
Authorized Official - Middle Name:SIMS
Authorized Official - Last Name:CRUMBY
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP-C
Authorized Official - Phone:915-202-4370
Mailing Address - Street 1:3950 COBB PKWY NW STE 801
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-9524
Mailing Address - Country:US
Mailing Address - Phone:678-889-0487
Mailing Address - Fax:866-493-3521
Practice Address - Street 1:3950 COBB PKWY NW STE 801
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-9524
Practice Address - Country:US
Practice Address - Phone:678-889-0487
Practice Address - Fax:866-493-3521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1467558114OtherNPI