| NPI | 1396945515 |
|---|---|
| Former Legal Business Name | NORTHSIDE CHILDREN'S PEDIATRICS CENTER, PC |
| Entity Type | Organization |
| Authorized Contact | STEPHANIE HEATON ANDERSON RN Pnp, Member, And (Spouse Of Md) 770-720-6963 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA GA 54532) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: GA GA Physician 54532) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2012-01-24 |