1497513923 NPI number — NORTHWEST PEDIATRIC CARE

Table of content: (NPI 1497513923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497513923 NPI number — NORTHWEST PEDIATRIC CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST PEDIATRIC CARE
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:
1497513923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3950 COBB PKWY NW STE 801
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ACWORTH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30101-9524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-889-0487
Provider Business Mailing Address Fax Number:
866-493-3521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3950 COBB PKWY NW STE 801
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ACWORTH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30101-9524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-889-0487
Provider Business Practice Location Address Fax Number:
866-493-3521
Provider Enumeration Date:
03/11/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CRUMBY
Authorized Official First Name:
CORA
Authorized Official Middle Name:
SIMS
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
915-202-4370

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1467558114 . This is a "NPI" identifier . This identifiers is of the category "OTHER".