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MAIN STREET INTERNAL MEDICINE & PEDIATRICS PC NPI 1619155306


NPI Information

NPI: 1619155306
Provider Name: MAIN STREET INTERNAL MEDICINE & PEDIATRICS PC

Doing Business As: MAIN STREET PEDIATRICS PC

Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 11D1076787

Address:
401 S MAIN ST
SUITE C5
ALPHARETTA, GA
ZIP 30009
Phone: (678) 205-2437
Get Directions

MAIN STREET INTERNAL MEDICINE & PEDIATRICS PC is a pediatrics in Alpharetta, 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. MAIN STREET INTERNAL MEDICINE & PEDIATRICS PC NPI is 1619155306. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Main Street Pediatrics Pc.

The provider's business location address is:

401 S MAIN ST
SUITE C5
ALPHARETTA, GA
ZIP 30009-960
Phone: (678) 205-2437
Fax: (678) 205-2439

The provider's authorized official is Maribel Labindalawa Angka Servera .
The authorized official title is Physician and has the following contact phone number (678) 205-2437.

The CLIA number assigned to this NPI record is 11D1076787 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/5/2008 and was last updated on 1/22/2009.


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
1207R00000XInternal Medicine047657GEORGIANo
2208000000XPediatrics047388GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1000884804CMEDICAIDGEORGIA
2000860054DMEDICAIDGEORGIA

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: 11/14/2023

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