Penny M Forman Blitzer, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0050077 Issued in GA

Practice address

4310 Johns Creek Pkwy
Suite 150
Suwanee, GA 30024-6091

Phone

(770) 476-4020

Fax

(770) 476-1674

NPI assigned

May 11, 2006

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pediatric Associates of Johns Creek PC

  • Pediatrics Physician
  • Suwanee, GA
  • NPI 1578685384
  NPD (past)

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1083664288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4190 FALLS RIDGE DR",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300228490",
            "telephone_number": "770-674-2585",
            "fax_number": "770-476-1674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 JOHNS CREEK PKWY",
            "address_2": "SUITE 150",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246091",
            "telephone_number": "770-476-4020",
            "fax_number": "770-476-1674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN BLITZER",
        "first_name": "PENNY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "0050077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.