1326269598 NPI number — KIDS FIRST PEDIATRICS OF GEORGIA, P.C.

Table of content: (NPI 1326269598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326269598 NPI number — KIDS FIRST PEDIATRICS OF GEORGIA, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDS FIRST PEDIATRICS OF GEORGIA, P.C.
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:
6
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:
1326269598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 668
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POOLER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31322-0668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-748-4527
Provider Business Mailing Address Fax Number:
912-748-9016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 CANAL ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
POOLER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31322-6007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-748-4527
Provider Business Practice Location Address Fax Number:
912-748-9016
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
912-748-4527

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: 000725381B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326048992 . This is a "PEDIATRICS-DR FRANCISCO J. HERRAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 837258124C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 897572509A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000835535B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144213018 . This is a "PEDIATRICS-DR KAREN M. KIM" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 897572509B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000839682D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1811980741 . This is a "PEDIATRICS-DR ROLANDO Z. MANALO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1831188259 . This is a "PEDIATRICS-DR YOLANDA M. RIVERA-CAUDILL" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000725381C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 920085272B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000835535C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 897572509C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000835535D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 837258124A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000839682B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 920085272C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1033307293 . This is a "PEDIATRICS-DR KARA L. KENNEDY" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1134193642 . This is a "PEDIATRICS-DR RONALD G.JONES" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com