Provider Demographics
NPI:1902026651
Name:CHILDS, HIRAM P (PA-C)
Entity Type:Individual
Prefix:MR
First Name:HIRAM
Middle Name:P
Last Name:CHILDS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:770-962-4895
Mailing Address - Fax:770-962-4792
Practice Address - Street 1:631 PROFESSIONAL DR
Practice Address - Street 2:SUITE 360
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045
Practice Address - Country:US
Practice Address - Phone:770-962-4895
Practice Address - Fax:770-962-4792
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100001620CMedicaid
GAR55576Medicare UPIN
GA97WCFPZMedicare ID - Type Unspecified