Provider Demographics
NPI:1740550896
Name:BUFORD PEDIATRICS,LLC
Entity type:Organization
Organization Name:BUFORD PEDIATRICS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRMALA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARADWAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-804-9398
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30515-0699
Mailing Address - Country:US
Mailing Address - Phone:678-804-9398
Mailing Address - Fax:678-804-9415
Practice Address - Street 1:3700 RIDGE RD
Practice Address - Street 2:SUITE'B'
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4035
Practice Address - Country:US
Practice Address - Phone:678-804-9398
Practice Address - Fax:678-804-9415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044838261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care