Main Street Pediatrics Pc
LBN: Main Street Internal Medicine & Pediatrics Pc
Main Street Pediatrics Pc is an health care organization with primary practice located at 401 S Main St Suite C5, Alpharetta GA 30009-7960. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is the primary health care specialty.
Main Street Internal Medicine & Pediatrics Pc can be contacted via phone (678) 205-2437, or through Angka Servera, Maribel Labindalawa via phone (678) 205-2437.
Contact Information
Primary practice address
401 S Main St Suite C5
Alpharetta GA 30009-7960
Phone: (678) 205-2437
Fax: (678) 205-2439
Website:
Authorized official contact:
Name: Angka Servera, Maribel Labindalawa Doctor of Medicine (MD)
Phone: (678) 205-2437
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 047657 | Georgia |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 047388 | Georgia |
Profile Details
| NPI number | 1619155306 |
|---|---|
| LBN Legal business name | Main Street Internal Medicine & Pediatrics Pc |
| DBA Doing business as | Main Street Pediatrics Pc |
| Authorized official | Angka Servera, Maribel Labindalawa Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Feb 5th, 2008 |
| Last updated | Jan 22nd, 2009 - about 15 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619155306 | NPPES |
| Georgia | MEDICAID | 000860054D | |
| Georgia | MEDICAID | 000884804C |
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