North Fulton Pediatrics

Directions

Our office is located at 1285 Hembree Road in the Roswell Medical Center complex.
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Office Hours

Monday - Friday
8:30 A.M. - 5:00 P.M.
Wednesdays
8:30 A.M. - 7:00 P.M.
Checkups only after 4:00 P.M.
Saturday
8:30 A.M. - 11:00 A.M.
Note: Saturday appointments available for sick visits only.
Phone: 770-442-1050

Forms


As needed, we can refer you to our network of specialists.

Referrals

To request a referral for additional visits to a specialist to whom we have previously referred your child, please fill out the form below and click submit and our Referral Office will give you a call shorly.

Required fields are in bold type.

Referrals Form

Patients Last Name
Patients First Name
Patients Middle Initial
Date of Birth
Parent/Guardian Home Telephone
Parent/Guardian Cell Telephone
Parent/Guardian Email

This form is only to be used if you are requesting additional visits to a specialist to whom we have previously referred you. Please call our Referral Coordinator at 770-442-1050 ext. 245 for all other referral requests.

Questions

Primary Care Physician (PCP) listed on Insurance Card
Insurance Company Name
Type of Insurance Plan (HMO or POS)
Insurance Company Telephone
Patient's Policy ID number
Group
Name of Insured
Type of Specialist
Name of Specialist
Specialist's Office Telephone
Specialist's Fax # (if known)
Reason for Referral (diagnosis)
Date of appointment to be seen by Specialist