Provider Demographics
NPI:1851708820
Name:SAGE HILL PEDIATRICS
Entity Type:Organization
Organization Name:SAGE HILL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-745-4578
Mailing Address - Street 1:1799 BRIARCLIFF RD NE
Mailing Address - Street 2:SUITE X
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2134
Mailing Address - Country:US
Mailing Address - Phone:404-745-4578
Mailing Address - Fax:
Practice Address - Street 1:1799 BRIARCLIFF RD NE
Practice Address - Street 2:SUITE X
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-2134
Practice Address - Country:US
Practice Address - Phone:404-745-4578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31923261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care