Provider Demographics
NPI:1598125312
Name:PEDIATRICS AND ADULT MEDICINE INC.
Entity Type:Organization
Organization Name:PEDIATRICS AND ADULT MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-639-7993
Mailing Address - Street 1:4153 FLAT SHOALS PKWY BLD C
Mailing Address - Street 2:SUITE 300B
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-4106
Mailing Address - Country:US
Mailing Address - Phone:404-386-6510
Mailing Address - Fax:404-500-2097
Practice Address - Street 1:4153 FLAT SHOALS PKWY BLD C
Practice Address - Street 2:SUITE 300B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4106
Practice Address - Country:US
Practice Address - Phone:404-386-6510
Practice Address - Fax:404-500-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherIRS INDIVIDUAL TAXPAYER IDENTIFICATION NUMBER