Provider Demographics
NPI:1841778081
Name:SUN PEDIATRICS LLC
Entity type:Organization
Organization Name:SUN PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MEENAKSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-327-8985
Mailing Address - Street 1:2520 WINDY HILL RD SE STE 104
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8633
Mailing Address - Country:US
Mailing Address - Phone:678-501-5601
Mailing Address - Fax:678-384-7163
Practice Address - Street 1:2520 WINDY HILL RD SE STE 104
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067
Practice Address - Country:US
Practice Address - Phone:678-501-5601
Practice Address - Fax:678-384-7163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003135564AMedicaid