Provider Demographics
NPI:1881727493
Name:SOUTH DEKALB PEDIATRICS, P.C.
Entity type:Organization
Organization Name:SOUTH DEKALB PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRIMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-243-9630
Mailing Address - Street 1:2855 CANDLER RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-1415
Mailing Address - Country:US
Mailing Address - Phone:404-243-9630
Mailing Address - Fax:404-241-5015
Practice Address - Street 1:2855 CANDLER RD
Practice Address - Street 2:SUITE 9
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-1415
Practice Address - Country:US
Practice Address - Phone:404-243-9630
Practice Address - Fax:404-241-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty