1346738457 NPI number — ALLIANCE PEDIATRIC PROVIDERS LLC

Table of content: (NPI 1346738457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346738457 NPI number — ALLIANCE PEDIATRIC PROVIDERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE PEDIATRIC PROVIDERS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346738457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 WESTRIDGE INDUSTRIAL BLVD STE 380
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCDONOUGH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30253-4214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-389-1525
Provider Business Mailing Address Fax Number:
470-300-3550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 WESTRIDGE INDUSTRIAL BLVD
Provider Second Line Business Practice Location Address:
STE 380
Provider Business Practice Location Address City Name:
MCDONOUGH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30253-4214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-389-1525
Provider Business Practice Location Address Fax Number:
470-300-3550
Provider Enumeration Date:
04/24/2018

Additional Information

Authorized Official

Authorized Official Last Name:
PITMAN
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
RN, DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
770-389-1525

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  075-R-1954 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: 075-R-1954 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003210228A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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