Provider Demographics
NPI:1871292979
Name:PEDIATRIC WORKS
Entity type:Organization
Organization Name:PEDIATRIC WORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WORKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-301-2191
Mailing Address - Street 1:6065 LAKE FORREST DR STE 250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3868
Mailing Address - Country:US
Mailing Address - Phone:404-301-2191
Mailing Address - Fax:404-301-4177
Practice Address - Street 1:6065 LAKE FORREST DR STE 250
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3868
Practice Address - Country:US
Practice Address - Phone:404-301-2191
Practice Address - Fax:404-301-4177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care