Provider Demographics
NPI:1487903829
Name:AMAZING PEDIATRICS
Entity type:Organization
Organization Name:AMAZING PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BUTLER-RICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-238-6495
Mailing Address - Street 1:2403 LAWRENCEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3200
Mailing Address - Country:US
Mailing Address - Phone:770-696-2968
Mailing Address - Fax:678-691-3460
Practice Address - Street 1:2403 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3200
Practice Address - Country:US
Practice Address - Phone:770-696-2968
Practice Address - Fax:678-691-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053678208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty