Provider Demographics
NPI:1194057851
Name:PIETY PEDIATRICS, P.C.
Entity type:Organization
Organization Name:PIETY PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS & INFO. SYSTEM
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:A
Authorized Official - Last Name:IFARINDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:678-736-6000
Mailing Address - Street 1:PO BOX 2192
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-0978
Mailing Address - Country:US
Mailing Address - Phone:678-736-6000
Mailing Address - Fax:678-736-6004
Practice Address - Street 1:4035 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30024-1253
Practice Address - Country:US
Practice Address - Phone:678-736-6000
Practice Address - Fax:678-736-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty