Provider Demographics
NPI:1639445414
Name:CANDLER PEDIATRICS LLC
Entity Type:Organization
Organization Name:CANDLER PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRIMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-464-0691
Mailing Address - Street 1:2855 CANDLER RD
Mailing Address - Street 2:STE 4
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-1415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2855 CANDLER RD
Practice Address - Street 2:STE 4
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-1415
Practice Address - Country:US
Practice Address - Phone:678-464-0691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty