Provider Demographics
NPI:1518110451
Name:PEDIA DOC CHILDREN'S MED CTR
Entity Type:Organization
Organization Name:PEDIA DOC CHILDREN'S MED CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DENNIS-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-344-2828
Mailing Address - Street 1:3088 CAMPBELLTON RD, SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-5410
Mailing Address - Country:US
Mailing Address - Phone:404-344-2828
Mailing Address - Fax:404-344-8384
Practice Address - Street 1:3088 CAMPBELLTON RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-5410
Practice Address - Country:US
Practice Address - Phone:404-344-2828
Practice Address - Fax:404-344-8384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty