NPIMap

Organization Active NPI

Pediatrics and Adolescent Medicine, PA

  • Pediatrics Physician
  • Marietta, GA
National Provider Identifier
1083746838
Registry record updated Aug 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
22123 Issued in GA
Legal business name
PEDIATRICS AND ADOLESCENT MEDICINE, PA
Practice address
2155 Post Oak Tritt Rd
Suite 100
Marietta, GA 30062-8620
Phone
(770) 973-4700
Fax
(770) 973-5460
NPI assigned
Mar 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2016

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

Authorized official

Name
Mrs. Susan Sevin
Title
Practice Administrator
Phone
(770) 973-4700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 22123 GA Primary

Addresses

Primary practice location

2155 Post Oak Tritt Rd
Suite 100
Marietta, GA 30062-8620

Mailing address

PO Box 102613
Atlanta, GA 30368-2613
Phone (770) 973-4700

Other names 1

  • pampa Other name

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
11D0259691Pediatrics & Adolescent Medicine PA2155 Post Oak Tritt Rd Ste 100, Marietta, GA 30062Certificate of waiverFeb 11, 2027

National Provider Directory

National Provider Directory

Locations

2155 Post Oak Tritt Rd
Ste 100
Marietta, GA 30062
Phone (770) 973-4700

11755 Pointe Pl
Ste C
Roswell, GA 30076
Phone (678) 893-8757

1230 Upper Hembree Rd
Ste 101
Roswell, GA 30076

100 Stoneforest Dr
Ste 300
Woodstock, GA 30189
Phone (770) 517-6804

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472169600000",
    "number": "1083746838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102613",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303682613",
            "telephone_number": "770-973-4700",
            "fax_number": "770-973-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 POST OAK TRITT RD",
            "address_2": "SUITE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300628620",
            "telephone_number": "770-973-4700",
            "fax_number": "770-973-5460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRICS AND ADOLESCENT MEDICINE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2016-08-26",
        "status": "A",
        "authorized_official_last_name": "SEVIN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "770-973-4700",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "22123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "pampa",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2016; 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.