NPIMap

Elizabeth Lynn Amodeo, MD

Individual provider Active NPI Pediatrics Physician · Kennesaw, GA

NPI 1447360326 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1447360326
Entity type
Individual (NPI type 1)
Primary specialty
Pediatrics Physician 208000000X
License
028736 (GA)
Practice address
750 Townpark Lane
Pediatrics Health Care Team a
Kennesaw, GA 30144
Phone
(770) 514-5455
Fax
(770) 514-5444
NPI assigned
Aug 30, 2006
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
028736GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Southeast Permanente Medical Group Pediatrics Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 028736 GA Yes

Addresses

Primary practice location

750 Townpark Lane
Pediatrics Health Care Team a
Kennesaw, GA 30144

Mailing address

3495 Piedmont Road NE
Nine Piedmont Center
Atlanta, GA 30305-1736
Phone (404) 364-7000

Other names

  • Elizabeth Lynn Bruce Former name

Other providers in Kennesaw, GA

All providers in Kennesaw, GA · Pediatrics Physician in Georgia

Sources for this page

Verify at the official NPI Registry.