Provider Type Icon

NORTHSIDE PEDIATRICS & ADOLESCENT MEDICINE PC NPI 1417077884


NPI Information

NPI: 1417077884
Provider Name: NORTHSIDE PEDIATRICS & ADOLESCENT MEDICINE PC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 11D2124088

Address:
1140 HAMMOND DRIVE
SUITE E5250
ATLANTA, GA
ZIP 30328
Phone: (404) 256-2688
Get Directions

NORTHSIDE PEDIATRICS & ADOLESCENT MEDICINE PC is a pediatrics in Atlanta, GA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. NORTHSIDE PEDIATRICS & ADOLESCENT MEDICINE PC NPI is 1417077884. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1140 HAMMOND DRIVE
SUITE E5250
ATLANTA, GA
ZIP 30328
Phone: (404) 256-2688
Fax: (404) 256-1820

The provider's authorized official is Vicki M Tittle .
The authorized official title is Practice Adminstrator and has the following contact phone number (404) 705-8990.

The CLIA number assigned to this NPI record is 11D2124088 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/30/2007 and was last updated on 8/22/2020.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsYes

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: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.