Provider Demographics
NPI:1629269865
Name:CHILDREN 1ST PEDIATRICS
Entity Type:Organization
Organization Name:CHILDREN 1ST PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-817-1000
Mailing Address - Street 1:101 BECKETT LN
Mailing Address - Street 2:SUITE 502
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7155
Mailing Address - Country:US
Mailing Address - Phone:678-817-1000
Mailing Address - Fax:678-817-1001
Practice Address - Street 1:101 BECKETT LN
Practice Address - Street 2:SUITE 502
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7155
Practice Address - Country:US
Practice Address - Phone:678-817-1000
Practice Address - Fax:678-817-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00436994DMedicaid