Provider Demographics
NPI:1922268838
Name:PEDIATRIC AND ADOLESCENT HEALTHCARE,PC
Entity Type:Organization
Organization Name:PEDIATRIC AND ADOLESCENT HEALTHCARE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:HOLZWARTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-971-5325
Mailing Address - Street 1:1163 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2764
Mailing Address - Country:US
Mailing Address - Phone:770-971-5325
Mailing Address - Fax:
Practice Address - Street 1:1163 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 170
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2764
Practice Address - Country:US
Practice Address - Phone:770-971-5325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0375702080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty