Provider Demographics
NPI:1902941503
Name:COVENANT CARE PEDIATRICS PC
Entity Type:Organization
Organization Name:COVENANT CARE PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-389-4543
Mailing Address - Street 1:245 COUNTRY CLUB DR BLDG 200A
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7212
Mailing Address - Country:US
Mailing Address - Phone:770-389-4543
Mailing Address - Fax:770-474-0566
Practice Address - Street 1:245 COUNTRY CLUB DR BLDG 200A
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7212
Practice Address - Country:US
Practice Address - Phone:770-389-4543
Practice Address - Fax:770-474-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty