Provider Demographics
NPI:1003119934
Name:UNITED PEDIATRICS PC
Entity type:Organization
Organization Name:UNITED PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYABA
Authorized Official - Middle Name:
Authorized Official - Last Name:FATEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-717-0033
Mailing Address - Street 1:4775 JIMMY CARTER BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3760
Mailing Address - Country:US
Mailing Address - Phone:770-717-0033
Mailing Address - Fax:770-717-0028
Practice Address - Street 1:4775 JIMMY CARTER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3760
Practice Address - Country:US
Practice Address - Phone:770-717-0033
Practice Address - Fax:770-717-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045783208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty