Provider Demographics
NPI:1891485462
Name:MINDFUL PEDIATRICS LLC
Entity Type:Organization
Organization Name:MINDFUL PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIYA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-305-9378
Mailing Address - Street 1:11705 JONES BRIDGE RD STE A201
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5080
Mailing Address - Country:US
Mailing Address - Phone:678-972-1952
Mailing Address - Fax:
Practice Address - Street 1:11705 JONES BRIDGE RD STE A201
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30005-5080
Practice Address - Country:US
Practice Address - Phone:678-972-1952
Practice Address - Fax:678-737-1858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty