Provider Demographics
NPI:1346738457
Name:ALLIANCE PEDIATRIC PROVIDERS LLC
Entity type:Organization
Organization Name:ALLIANCE PEDIATRIC PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:PITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-389-1525
Mailing Address - Street 1:115 WESTRIDGE INDUSTRIAL BLVD STE 380
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4214
Mailing Address - Country:US
Mailing Address - Phone:770-389-1525
Mailing Address - Fax:470-300-3550
Practice Address - Street 1:115 WESTRIDGE INDUSTRIAL BLVD
Practice Address - Street 2:STE 380
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4214
Practice Address - Country:US
Practice Address - Phone:770-389-1525
Practice Address - Fax:470-300-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075-R-1954253Z00000X, 251J00000X, 376K00000X, 163WA2000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Yes251J00000XAgenciesNursing CareGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003210228AMedicaid