Northside Children's Pediatric Center, LLC

NPI #1396945515 in Canton, Georgia

Provider Information

NPI Number: 1396945515
Entity Type: Organization
Organization Name: Northside Children's Pediatric Center, LLC
Primary Specialty: Pediatrics
Enumeration Date: Jul 25, 2007
Last Updated: Jan 24, 2012

Practice Location

Address: 391 EAST MAIN STREET
Address 2: HISTORIC HAWKINS BUILDING
City: Canton
State: Georgia
ZIP Code: 30114-2712
Phone: (770) 720-6963

Authorized Official

Name: PROF. STEPHANIE HEATON ANDERSON, DNP, PNP, RNC
Title: RN-PNP, MEMBER, AND (SPOUSE OF MD)
Phone: (770) 720-6963

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Primary Care — Primary Care	261QP2300X
Pediatrics	208000000X	Primary

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