Provider Demographics
NPI:1821355447
Name:JUST US KIDS PEDIATRICS, PC
Entity Type:Organization
Organization Name:JUST US KIDS PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-491-7657
Mailing Address - Street 1:2462 HIGHWAY 34 EAST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265
Mailing Address - Country:US
Mailing Address - Phone:770-683-5437
Mailing Address - Fax:770-683-3758
Practice Address - Street 1:2462 HIGHWAY 34 EAST
Practice Address - Street 2:SUITE A
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265
Practice Address - Country:US
Practice Address - Phone:770-683-5437
Practice Address - Fax:770-683-3758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208000000X
GA47777261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073560959OtherINDIVIDUAL NPI
GA47777OtherGEORGIA LICENSE
GA47777OtherGEORGIA LICENSE