Provider Demographics
NPI:1144891524
Name:PRIDE PEDIATRICS, INC
Entity type:Organization
Organization Name:PRIDE PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:SCHNELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:PNP-PC, DNP
Authorized Official - Phone:470-236-6366
Mailing Address - Street 1:2100 RIVERSIDE PKWY, STE 128
Mailing Address - Street 2:#131
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043
Mailing Address - Country:US
Mailing Address - Phone:470-236-6366
Mailing Address - Fax:
Practice Address - Street 1:1442 SUGAR MAPLE WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5247
Practice Address - Country:US
Practice Address - Phone:470-236-6366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service