NPIMap

Organization Active NPI

Kids Time Pediatrics - East Cobb LLC

Doing business as Kids Time Pediatrics

  • Pediatric Adolescent Medicine Physician
  • Madison, GA
National Provider Identifier
1184935223
Registry record updated Jun 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
32201 Issued in GA
Legal business name
KIDS TIME PEDIATRICS - EAST COBB LLC
Doing business as
Kids Time Pediatrics
Practice address
696 Billups Ave
Madison, GA 30650-1439
Phone
(706) 342-2180
NPI assigned
Jun 23, 2010
Last updated
Jun 23, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2010

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

Authorized official

Name
Flynn Clyburn
Title
Manager
Phone
(706) 342-2180

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X 32201 GA Primary

Addresses

Primary practice location

696 Billups Ave
Madison, GA 30650-1439

Mailing address

3535 Roswell Rd
Suite 54
Marietta, GA 30062-8826
Phone (404) 943-1979

Other names 1

  • Kids Time Pediatrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kids Time Pediatrics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1277251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277251200000",
    "number": "1184935223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 ROSWELL RD",
            "address_2": "SUITE 54",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300628826",
            "telephone_number": "404-943-1979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "696 BILLUPS AVE",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "306501439",
            "telephone_number": "706-342-2180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS TIME PEDIATRICS - EAST COBB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-23",
        "last_updated": "2010-06-23",
        "status": "A",
        "authorized_official_last_name": "CLYBURN",
        "authorized_official_first_name": "FLYNN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "706-342-2180"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "GA",
            "license": "32201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kids Time Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2010; 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.