Provider Demographics
NPI:1457375073
Name:INTOWN PEDIATRIC AND ADOLESCENT MEDICINE
Entity type:Organization
Organization Name:INTOWN PEDIATRIC AND ADOLESCENT MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENETA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-446-4726
Mailing Address - Street 1:490 BILL KENNEDY WAY SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-6835
Mailing Address - Country:US
Mailing Address - Phone:404-446-4726
Mailing Address - Fax:404-446-4727
Practice Address - Street 1:490 BILL KENNEDY WAY SE
Practice Address - Street 2:SUITE 101
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-6835
Practice Address - Country:US
Practice Address - Phone:404-446-4726
Practice Address - Fax:404-446-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty