Provider Demographics
NPI:1699951657
Name:ATLANTA PEDIATRIC SURGERY PC
Entity type:Organization
Organization Name:ATLANTA PEDIATRIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHNABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-904-9287
Mailing Address - Street 1:1975 CENTURY BLVD NE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3316
Mailing Address - Country:US
Mailing Address - Phone:404-982-9938
Mailing Address - Fax:
Practice Address - Street 1:1975 CENTURY BLVD NE
Practice Address - Street 2:SUITE 6
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3316
Practice Address - Country:US
Practice Address - Phone:404-982-9938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300028887AMedicaid
GRP3179Medicare PIN