Provider Demographics
NPI:1720117989
Name:KIDS FIRST PEDIATRIC GROUP, LLC
Entity Type:Organization
Organization Name:KIDS FIRST PEDIATRIC GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:YOUNGBLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-506-2212
Mailing Address - Street 1:1045 SOUTHCREST DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6113
Mailing Address - Country:US
Mailing Address - Phone:770-507-2212
Mailing Address - Fax:770-507-2213
Practice Address - Street 1:1045 SOUTHCREST DR
Practice Address - Street 2:SUITE 110
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6113
Practice Address - Country:US
Practice Address - Phone:770-507-2212
Practice Address - Fax:770-507-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty