Pediatric Development Center of Atlanta, LLC

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

Legal business name

PEDIATRIC DEVELOPMENT CENTER OF ATLANTA, LLC

Practice address

2694 Hughes St SE
Smyrna, GA 30080-1920

Phone

(770) 405-8542

NPI assigned

Jun 2, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Michael J. Wing

Title

Vice President

Phone

(207) 831-8871

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212364800000",
    "number": "1154580553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2694 HUGHES ST SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300801920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2694 HUGHES ST SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300801920",
            "telephone_number": "770-405-8542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DEVELOPMENT CENTER OF ATLANTA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-02",
        "last_updated": "2008-06-02",
        "status": "A",
        "authorized_official_last_name": "WING",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "207-831-8871",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry at Vinings
• Arnold Louis Peluso, LMT
• Kaylin Pena, CSFA,CST
• Hayley Grace Pennell, DC
• Jessica Perez, LCSW
• Danykia Chandrelle Perine, PT

• Pediatric Occupational Therapist in Smyrna, GA
• Providers in Smyrna, GA by specialty
• Pediatric Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; 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.