Provider Demographics
NPI:1396051355
Name:ADVANCED CARE PEDIATRICS, INC.
Entity type:Organization
Organization Name:ADVANCED CARE PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-431-8931
Mailing Address - Street 1:55 IVAN ALLEN JR BLVD NW
Mailing Address - Street 2:SUITE 525
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-3050
Mailing Address - Country:US
Mailing Address - Phone:404-835-3512
Mailing Address - Fax:404-521-4444
Practice Address - Street 1:55 IVAN ALLEN JR BLVD NW
Practice Address - Street 2:SUITE 525
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-3050
Practice Address - Country:US
Practice Address - Phone:404-835-3512
Practice Address - Fax:404-521-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care