Provider Demographics
NPI:1497865935
Name:CHILDFREN'S MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:CHILDFREN'S MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:JANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-633-4595
Mailing Address - Street 1:1875 CENTURY BLVD NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3319
Mailing Address - Country:US
Mailing Address - Phone:404-633-4595
Mailing Address - Fax:404-633-6711
Practice Address - Street 1:1875 CENTURY BLVD NE
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3319
Practice Address - Country:US
Practice Address - Phone:404-633-4595
Practice Address - Fax:404-633-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty