Provider Demographics
NPI:1972695260
Name:PEDIATRIX MEDICAL GROUP OF GA PC
Entity Type:Organization
Organization Name:PEDIATRIX MEDICAL GROUP OF GA PC
Other - Org Name:ATLANTA MATERNAL-FETAL MEDICINE AN AFFILIATE OF OBSTETRIX MEDICAL GROU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-384-0175
Mailing Address - Street 1:1300 SAWGRASS CORPORATE PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2843
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:954-851-1948
Practice Address - Street 1:1301 CONCORD TER
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2843
Practice Address - Country:US
Practice Address - Phone:954-384-0175
Practice Address - Fax:954-851-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300041899AMedicaid
GA300041899AMedicaid