Provider Demographics
NPI:1851494447
Name:CRESCENT PEDIATRICS
Entity Type:Organization
Organization Name:CRESCENT PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MONEIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-495-6222
Mailing Address - Street 1:2925 PREMIERE PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:770-495-6222
Mailing Address - Fax:770-495-9959
Practice Address - Street 1:2925 PREMIERE PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:770-495-6222
Practice Address - Fax:770-495-9959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034204173000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000449611CMedicaid
1207077OtherUNITED HEALTHCARE
GA4308928OtherAETNA
72291OtherCOVENTRY
313452OtherWELLCARE
GA52062819002OtherBC
GA85001694GMedicaid
10037067OtherAMERIGROUP
912801OtherCIGNA
GA4308928OtherAETNA
72291OtherCOVENTRY