EXCELLENT PEDIATRICS NPI 1104141837

NPI Information

NPI: 1104141837
Provider Name: EXCELLENT PEDIATRICS
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 11D1046154

Address:
333 ALCOVY ST
SUITE 5
MONROE, GA
ZIP 30655
Phone: (678) 807-2230
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EXCELLENT PEDIATRICS is a primary care clinic center in Monroe, GA. EXCELLENT PEDIATRICS NPI is 1104141837. The provider is registered as an organization entity type.

The provider's business location address is:

333 ALCOVY ST
SUITE 5
MONROE, GA
ZIP 30655-180
Phone: (678) 807-2230

The provider's authorized official is Roger Morales .
The authorized official title is Owner and has the following contact phone number (678) 807-2241.

The CLIA number assigned to this NPI record is 11D1046154 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/6/2010 and was last updated on 4/6/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	055771	GEORGIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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