Provider Demographics
NPI:1972633089
Name:PEDIATRICS ALPHA
Entity Type:Organization
Organization Name:PEDIATRICS ALPHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALPHONSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERINJERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-922-9205
Mailing Address - Street 1:1524 WATSON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3484
Mailing Address - Country:US
Mailing Address - Phone:478-922-9205
Mailing Address - Fax:
Practice Address - Street 1:1524 WATSON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3484
Practice Address - Country:US
Practice Address - Phone:478-922-9205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039565208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAERI002OtherSECURE HEALTH
GA12-00400OtherUNITED HEALTHCARE
GA581785OtherBLUE CROSS OF GA
GA319475OtherWELLCARE
GA00655487BMedicaid