Provider Demographics
NPI:1972591238
Name:PEDIATRIC PARTNERS LLC
Entity Type:Organization
Organization Name:PEDIATRIC PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:EUBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-548-1216
Mailing Address - Street 1:1520B JENNINGS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2543
Mailing Address - Country:US
Mailing Address - Phone:706-548-1216
Mailing Address - Fax:706-548-1772
Practice Address - Street 1:1520B JENNINGS MILL RD
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2543
Practice Address - Country:US
Practice Address - Phone:706-548-1216
Practice Address - Fax:706-548-1772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA85002970GMedicaid