Provider Demographics
NPI:1922269182
Name:MOUNTAIN VIEWS PEDIATRICS
Entity Type:Organization
Organization Name:MOUNTAIN VIEWS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:404-508-1208
Mailing Address - Street 1:2754 N DECATUR RD STE 112
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5917
Mailing Address - Country:US
Mailing Address - Phone:404-508-1208
Mailing Address - Fax:
Practice Address - Street 1:2754 N DECATUR RD STE 112
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5917
Practice Address - Country:US
Practice Address - Phone:404-508-1208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020614208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00542066HMedicaid
GAF13632Medicare UPIN