Provider Demographics
NPI:1538686613
Name:CHILDRENS CLINIC LLC
Entity Type:Organization
Organization Name:CHILDRENS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-253-0170
Mailing Address - Street 1:931 LOWER FAYETTEVILLE RD STE J
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-5790
Mailing Address - Country:US
Mailing Address - Phone:770-253-0170
Mailing Address - Fax:770-253-0206
Practice Address - Street 1:931 LOWER FAYETTEVILLE RD STE J
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-5790
Practice Address - Country:US
Practice Address - Phone:770-253-0170
Practice Address - Fax:770-253-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty