Provider Demographics
NPI:1215989462
Name:PEDIATRICS AT BROOKSTONE CENTRE, PC
Entity type:Organization
Organization Name:PEDIATRICS AT BROOKSTONE CENTRE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NEHA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-571-9699
Mailing Address - Street 1:2001 BROOKSTONE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4572
Mailing Address - Country:US
Mailing Address - Phone:706-571-9699
Mailing Address - Fax:706-571-9565
Practice Address - Street 1:2001 BROOKSTONE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4572
Practice Address - Country:US
Practice Address - Phone:706-571-9699
Practice Address - Fax:706-571-9565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79092208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty