Provider Demographics
NPI:1487967360
Name:VAN METER PEDIATRIC ENDOCRINOLOGY
Entity type:Organization
Organization Name:VAN METER PEDIATRIC ENDOCRINOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIDLACK
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIALING CONT
Authorized Official - Phone:404-788-5237
Mailing Address - Street 1:1800 HOWELL MILL RD NW STE 450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2508
Mailing Address - Country:US
Mailing Address - Phone:404-355-4393
Mailing Address - Fax:678-961-2107
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 450
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2508
Practice Address - Country:US
Practice Address - Phone:678-961-2100
Practice Address - Fax:678-961-2107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTA DIABETES ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-20
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0611222080P0205X
GA0347342080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000468234GMedicaid