Organization
EGLESTON PEDIATRIC GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUETTA CODY (MANAGER, PROVIDER ENROLLMENT)
(404) 785-7876
Entity
Organization
Contact information
Practice address
1405 CLIFTON RD NE, ATLANTA, GA 30322-1060
(404) 785-6000
Mailing address
1575 NE EXPRESSWAY, ATLANTA, GA 30329-2401
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
2080P0203X
Pediatric Critical Care Medicine Physician
—
—
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
—
—
2080P0205X
Pediatric Endocrinology Physician
—
—
363AM0700X
Medical Physician Assistant
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
363LP0222X
Critical Care Pediatric Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
01/22/2007
Last updated
01/16/2025
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