Performance Pediatrics And Sports Medicine, Llc

LBN: Performance Pediatrics And Sports Medicine, Llc
Performance Pediatrics And Sports Medicine, Llc is an health care organization with primary practice located at 1181 Langford Dr Bldg 200-101, Bogart GA 30622-2542. The organization recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is the primary health care specialty. Performance Pediatrics And Sports Medicine, Llc can be contacted via phone (706) 207-6694, or through Merritt, Tara Ann via phone (706) 202-3236.

Contact Information

Primary practice address
1181 Langford Dr Bldg 200-101 Bogart GA 30622-2542
Phone: (706) 207-6694
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Merritt, Tara Ann Doctor of Medicine (MD)
Phone: (706) 202-3236

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 58543 Georgia
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 58543 Georgia
Allopathic & Osteopathic Physicians / Sports Medicine 2080S0010X 58543 Georgia

Profile Details

NPI number 1295081321
LBN Legal business name Performance Pediatrics And Sports Medicine, Llc
DBA Doing business as
Authorized official Merritt, Tara Ann Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Jul 26th, 2012
Last updated Jul 26th, 2012 - about 13 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295081321 NPPES
Georgia Other 58543 STATE MEDICAL LICENSE
Georgia MEDICAID 003125239A STATE MEDICAL LICENSE
Georgia MEDICAID 489449582C STATE MEDICAL LICENSE

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