Provider Demographics
NPI:1972756732
Name:NUESTROS NINOS OUR KIDS PEDIATRICS INC.
Entity Type:Organization
Organization Name:NUESTROS NINOS OUR KIDS PEDIATRICS INC.
Other - Org Name:NUESTROS NINOS Y LA FAMILA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:770-732-6007
Mailing Address - Street 1:777 FRANKLIN RD SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-7803
Mailing Address - Country:US
Mailing Address - Phone:770-732-6007
Mailing Address - Fax:770-732-8242
Practice Address - Street 1:777 FRANKLIN RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7803
Practice Address - Country:US
Practice Address - Phone:770-732-6007
Practice Address - Fax:770-732-8242
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NUESTROS NINOS OUR KIDS PEDIATRICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-24
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170709NP363LF0000X
GARN184208NP363LF0000X
GARN083997NP363LP0200X
GARN140783NP363LP0200X
GARN054213NP363LP0200X
GARN117846NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA818552480AMedicaid