Provider Demographics
NPI:1669668125
Name:MCDONOUGH PEDIATRICS
Entity Type:Organization
Organization Name:MCDONOUGH PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:SEKHAR
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANKARAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-957-8626
Mailing Address - Street 1:101 REGENCY PARK DR
Mailing Address - Street 2:STE 140
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 REGENCY PARK DR
Practice Address - Street 2:STE 140
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7080
Practice Address - Country:US
Practice Address - Phone:770-957-8626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031549208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty