NPIMap

Organization Active NPI

Prime Pediatrics PC

  • Pediatric Adolescent Medicine Physician
  • Dalton, GA
National Provider Identifier
1053578450
Registry record updated May 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
37896 Issued in GA
Legal business name
PRIME PEDIATRICS PC
Practice address
1610 Broadrick Dr
Dalton, GA 30720-3012
Phone
(706) 279-1994
Fax
(706) 279-9229
NPI assigned
May 22, 2008
Last updated
May 22, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2008

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

Authorized official

Name
Ms. Debbie W Chadwick
Title
Office Manager
Phone
(706) 279-1994

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X 37896 GA Primary

Addresses

Primary practice location

1610 Broadrick Dr
Dalton, GA 30720-3012

Mailing address

1610 Broadrick Dr
Dalton, GA 30720-3012
Phone (706) 279-1994

Other identifiers 4

IdentifierTypeStateIssuer
000572525CMedicaidGA
964266319AMedicaidGA
803486775AMedicaidGA
000910214AMedicaidGA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0976863Prime Pediatrics PC1610 Broadrick Drive, Dalton, GA 30720ComplianceNov 1, 2026

National Provider Directory

National Provider Directory

Locations

1610 Broadrick Dr
Dalton, GA 30720
Phone (706) 279-1994

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211414400000",
    "number": "1053578450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 BROADRICK DR",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307203012",
            "telephone_number": "706-279-1994",
            "fax_number": "706-279-9229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 BROADRICK DR",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307203012",
            "telephone_number": "706-279-1994",
            "fax_number": "706-279-9229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-22",
        "last_updated": "2008-05-22",
        "status": "A",
        "authorized_official_last_name": "CHADWICK",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "706-279-1994",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "GA",
            "license": "37896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000572525C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "964266319A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "803486775A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000910214A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dalton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.