Georgia Center for Autism and Developmental Pediatrics, LLC

Primary specialty

Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X

Legal business name

GEORGIA CENTER FOR AUTISM AND DEVELOPMENTAL PEDIATRICS, LLC

Practice address

6065 Roswell Rd Ste 470
Sandy Springs, GA 30328-4067

Phone

(770) 824-3395

Fax

(770) 691-5116

NPI assigned

Mar 5, 2020

Last updated

Apr 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Daniel Moncino, MD

Title

Ceo

Phone

(404) 748-6013

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587513600000",
    "number": "1154956621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6065 ROSWELL RD STE 470",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303284067",
            "telephone_number": "404-748-6013",
            "fax_number": "866-984-3407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6065 ROSWELL RD STE 470",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303284067",
            "telephone_number": "770-824-3395",
            "fax_number": "770-691-5116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA CENTER FOR AUTISM AND DEVELOPMENTAL PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-05",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A",
        "authorized_official_last_name": "MONCINO",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-748-6013",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmental - Behavioral Pediatrics Physician in Sandy Springs, GA
• Providers in Sandy Springs, GA by specialty
• Developmental - Behavioral Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.