Provider Demographics
NPI:1659064921
Name:PEDSMD LLC
Entity Type:Organization
Organization Name:PEDSMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CEO
Authorized Official - Prefix:
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-960-8316
Mailing Address - Street 1:4941 S OLD PEACHTREE RD STE B
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3495
Mailing Address - Country:US
Mailing Address - Phone:678-960-8316
Mailing Address - Fax:678-550-6569
Practice Address - Street 1:4941 S OLD PEACHTREE RD STE B
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-3495
Practice Address - Country:US
Practice Address - Phone:678-960-8316
Practice Address - Fax:678-550-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty