Provider Demographics
NPI:1053416669
Name:MEDLOCK PEDIATRICS PC
Entity type:Organization
Organization Name:MEDLOCK PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BATLLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-813-9775
Mailing Address - Street 1:3497 DULUTH PARK LANE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:770-813-9775
Mailing Address - Fax:770-813-8976
Practice Address - Street 1:3497 DULUTH PARK LANE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-813-9775
Practice Address - Fax:770-813-8976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA85000772GMedicaid