Provider Demographics
NPI:1821315326
Name:STORYBOOK PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:STORYBOOK PEDIATRICS, P.C.
Other - Org Name:RON SMITH MD PEDIATRICS & ADOLESCENT MEDICINE, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-583-9071
Mailing Address - Street 1:130 ENTERPRISE PKWY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-9000
Mailing Address - Country:US
Mailing Address - Phone:978-583-9071
Mailing Address - Fax:678-583-9319
Practice Address - Street 1:130 ENTERPRISE PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-9000
Practice Address - Country:US
Practice Address - Phone:978-583-9071
Practice Address - Fax:678-583-9319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000794197Medicaid