OrganizationActive
Performance Pediatrics and Sports Medicine, LLC
NPI 1295081321 · Pediatric Sports Medicine Physician · Bogart, GA
Provider details
- NPI number
- 1295081321
- Entity type
- Organization
- Primary specialty
- Pediatric Sports Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Tara Merritt, Owner Physician(706) 202-3236
- License
- 58543 (GA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
1181 Langford Dr
Bldg 200-101
Bogart, GA 30622-2542
Phone: (706) 207-6694
Approximate (ZIP-level) locationGet directions
Mailing address
1181 Langford Dr
Bogart, GA 30622-2542
Registry dates
- Enumerated
- 2012-07-26
- Last updated
- 2012-07-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.