NPIMap

Organization Active NPI

Woodstock Pediatrics PC

  • Pediatrics Physician
  • Blue Ridge, GA
National Provider Identifier
1104159086
Registry record updated Jan 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
032063 Issued in GA
Legal business name
WOODSTOCK PEDIATRICS PC
Practice address
460 W Main St
Suite 100
Blue Ridge, GA 30513-7127
Phone
(706) 632-0330
Fax
(706) 632-9004
NPI assigned
Sep 10, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2011

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

Authorized official

Name
Dr. Kimberly T Williams, M.D.NPI 1023073723
Title
M.D.
Phone
(706) 632-0330

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 032063 GA Primary

Addresses

Primary practice location

460 W Main St
Suite 100
Blue Ridge, GA 30513-7127

Mailing address

460 W Main St
Suite 100
Blue Ridge, GA 30513-7127
Phone (706) 632-0330

Other identifiers 1

IdentifierTypeStateIssuer
000448269FMedicaidGA

Other names 1

  • Main Street Pediatrics Doing business as

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
11D0985933Woodstock Pediatrics PC460 West Main Street, Suite 100, Blue Ridge, GA 30513Certificate of waiverMay 1, 2027

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/7193/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 2

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": "1252540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296432000000",
    "number": "1104159086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 W MAIN ST",
            "address_2": "SUITE 100",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "305137127",
            "telephone_number": "706-632-0330",
            "fax_number": "706-632-9004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 W MAIN ST",
            "address_2": "SUITE 100",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "305137127",
            "telephone_number": "706-632-0330",
            "fax_number": "706-632-9004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODSTOCK PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-10",
        "last_updated": "2011-01-31",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "706-632-0330",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "032063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000448269F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blue Ridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2011; 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.