Provider Demographics
NPI:1821461484
Name:CHILDREN 1ST PEDIATRICS
Entity Type:Organization
Organization Name:CHILDREN 1ST PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-817-1000
Mailing Address - Street 1:101 BECKETT LN
Mailing Address - Street 2:SUITE 502
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7155
Mailing Address - Country:US
Mailing Address - Phone:678-817-1000
Mailing Address - Fax:
Practice Address - Street 1:101 BECKETT LN
Practice Address - Street 2:SUITE 502
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7155
Practice Address - Country:US
Practice Address - Phone:678-817-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN090519261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care