Provider Demographics
NPI:1730696840
Name:LITTLE AMIGOS PEDIATRIC SERVICES
Entity type:Organization
Organization Name:LITTLE AMIGOS PEDIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TANESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-585-1135
Mailing Address - Street 1:4180 NORMAN RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-1758
Mailing Address - Country:US
Mailing Address - Phone:404-798-1943
Mailing Address - Fax:
Practice Address - Street 1:7922 SONNY RDG
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-2218
Practice Address - Country:US
Practice Address - Phone:470-585-1135
Practice Address - Fax:470-585-1135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health