| Northside Children's Pediatric Center, Llc | |
|
391 East Main Street Historic Hawkins Building Canton GA 30114-2712 | |
| (770) 720-6963 | |
| (770) 720-6965 |
| Full Name | Northside Children's Pediatric Center, Llc |
|---|---|
| Speciality | Pediatrics |
| Location | 391 East Main Street, Canton, Georgia |
| Authorized Official Name and Position | Stephanie Heaton Anderson (RN-PNP, MEMBER, AND (SPOUSE OF MD)) |
| Authorized Official Contact | 7707206963 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northside Children's Pediatric Center, Llc 391 East Main Street Historic Hawkins Building Canton GA 30114-2712 Ph: (770) 720-6963 | Northside Children's Pediatric Center, Llc 391 East Main Street Historic Hawkins Building Canton GA 30114-2712 Ph: (770) 720-6963 |
| NPI Number | 1396945515 |
|---|---|
| Provider Enumeration Date | 07/25/2007 |
| Last Update Date | 01/24/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396945515 | NPI | - | NPPES |
| 629697125A | Medicaid | GA | |
| 1396945515 | Other | GA | AUTH REPRESENTATIVE: MICHAEL G. ANDERSON, MD, ENTITY ATTENDING PHYSICIAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | GA PHYSICIAN 54532 (Georgia) | Secondary |
| 208000000X | Pediatrics | GA 54532 (Georgia) | Primary |
Donna C. Haley, M.d., P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 687 Marietta Hwy, Canton, GA 30114 Phone: 770-479-8040 Fax: 770-479-7871 | |
Medical Associates Professional Services, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 320 Hospital Rd, Canton, GA 30114 Phone: 855-709-4535 | |
Medical Care Of Georgia, P.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 50 Medical Ln, Canton, GA 30114 Phone: 770-345-2300 Fax: 770-345-2330 | |
Dima Healthcare, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7768 Cumming Hwy Ste 300, Canton, GA 30115 Phone: 707-111-1111 | |
Mini-med Clinic Of North Georgia, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5113 Holly Springs Parkway, Canton, GA 30115 Phone: 470-331-3544 | |
Northcrest Family Medicine Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7768 Cumming Hwy, Suite 300, Canton, GA 30114 Phone: 770-720-2113 Fax: 770-704-7365 | |
Northside Medical Specialists Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 145 Riverstone Terrace, Suite 100, Canton, GA 30114 Phone: 770-704-9499 Fax: 770-704-9754 |