NPIMap

Organization Active NPI

Pediatrics of Dalton, PA

  • Specialist
  • Dalton, GA
National Provider Identifier
1063679207
Registry record updated Jun 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
015426 Issued in GA
Legal business name
PEDIATRICS OF DALTON, PA
Practice address
1409 Chattanooga Ave
Dalton, GA 30720-2631
Phone
(706) 278-5373
Fax
(706) 278-5085
NPI assigned
May 16, 2008
Last updated
Jun 17, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2015

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

Authorized official

Name
Mrs. Donna Dockery
Title
Administrator
Phone
(706) 278-5373

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 015426 GA Primary

Addresses

Primary practice location

1409 Chattanooga Ave
Dalton, GA 30720-2631

Mailing address

1409 Chattanooga Ave
Dalton, GA 30720-2631
Phone (706) 278-5373

Other identifiers 1

IdentifierTypeStateIssuer
30019480AMedicaidGA

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
11D0262391Pediatrics of Dalton1409 Chattanooga Avenue, Dalton, GA 30720AccreditationDec 22, 2027

National Provider Directory

National Provider Directory

Locations

1409 Chattanooga Ave
Dalton, GA 30720
Phone (706) 278-5373

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/7968/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 8

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": "1210896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434499200000",
    "number": "1063679207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 CHATTANOOGA AVE",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202631",
            "telephone_number": "706-278-5373",
            "fax_number": "706-278-5085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 CHATTANOOGA AVE",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202631",
            "telephone_number": "706-278-5373",
            "fax_number": "706-278-5085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRICS OF DALTON, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-16",
        "last_updated": "2015-06-17",
        "status": "A",
        "authorized_official_last_name": "DOCKERY",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "706-278-5373",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "015426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30019480A",
            "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 Jun 17, 2015; 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.