| NPI | 1811041452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUETTA CODY Manager, Provider Enrollment 404-785-7876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine | |
| 2080P0205X Pediatrics, Pediatric Endocrinology | |
| 363AM0700X Physician Assistant, Medical | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| 363LP0222X Nurse Practitioner, Pediatrics, Critical Care | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2023-03-28 |