Provider Demographics
NPI:1962039420
Name:THE M CENTER FOR INTEGRATIVE PEDIATRICS
Entity Type:Organization
Organization Name:THE M CENTER FOR INTEGRATIVE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAIA
Authorized Official - Middle Name:ALEES
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-381-8556
Mailing Address - Street 1:1240 UPPER HEMBREE RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-0914
Mailing Address - Country:US
Mailing Address - Phone:888-381-8556
Mailing Address - Fax:
Practice Address - Street 1:5050 RESEARCH CT STE 800
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6606
Practice Address - Country:US
Practice Address - Phone:888-381-8556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Single Specialty