NPIMap

Organization Active NPI

Pediatric Health Center of Conyers, PC

  • Pediatrics Physician
  • Dunwoody, GA
National Provider Identifier
1013079987
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC HEALTH CENTER OF CONYERS, PC
Practice address
4243 Dunwoody Club Dr Ste 103
Dunwoody, GA 30350-5206
Phone
(678) 336-5255
Fax
(678) 336-5259
NPI assigned
Dec 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Gladys H Goldberg, BSN
Title
Practice Manager, Sec/Treas of PC
Phone
(678) 336-5255

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X GA Primary

Addresses

Primary practice location

4243 Dunwoody Club Dr Ste 103
Dunwoody, GA 30350-5206

Mailing address

4243 Dunwoody Club Dr
Ste 103
Atlanta, GA 30350-5206
Phone (678) 336-5255

Other identifiers 2

IdentifierTypeStateIssuer
000068912EMedicaidGA
000945051BMedicaidGA

Other names 1

  • PEDIATRIC HEALTH CENTER Doing business as

National Provider Directory

National Provider Directory

Locations

4243 Dunwoody Club Dr
Ste 103
Dunwoody, GA 30350
Phone (678) 336-5255

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1013079987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4243 DUNWOODY CLUB DR",
            "address_2": "STE 103",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303505206",
            "telephone_number": "678-336-5255",
            "fax_number": "770-760-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4243 DUNWOODY CLUB DR STE 103",
            "city": "DUNWOODY",
            "state": "GA",
            "postal_code": "303505206",
            "telephone_number": "678-336-5255",
            "fax_number": "678-336-5259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC HEALTH CENTER OF CONYERS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GOLDBERG",
        "authorized_official_first_name": "GLADYS",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRACTICE MANAGER, SEC/TREAS OF PC",
        "authorized_official_telephone_number": "678-336-5255",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BSN"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000068912E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000945051B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEDIATRIC HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dunwoody, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.