Provider Demographics
NPI:1598383754
Name:NORCROSS PEDIATRIC AND FAMILY MEDICINE CORPORATION
Entity Type:Organization
Organization Name:NORCROSS PEDIATRIC AND FAMILY MEDICINE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-771-1616
Mailing Address - Street 1:4608 JIMMY CARTER BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4608 JIMMY CARTER BLVD STE 7
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3758
Practice Address - Country:US
Practice Address - Phone:770-938-6966
Practice Address - Fax:770-938-6968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN214390Medicaid