Provider Demographics
NPI:1427048685
Name:PRESTON RIDGE PEDIATRIC ASSOCIATES, PC
Entity type:Organization
Organization Name:PRESTON RIDGE PEDIATRIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAPCIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-751-6111
Mailing Address - Street 1:3400 OLD MILTON PKWY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3707
Mailing Address - Country:US
Mailing Address - Phone:770-751-6111
Mailing Address - Fax:770-772-6099
Practice Address - Street 1:3400 OLD MILTON PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-751-6111
Practice Address - Fax:770-772-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty