NPIMap

Organization Active NPI

Peach State Pediatrics

  • Pediatrics Physician
  • Smyrna, GA
National Provider Identifier
1215280177
Registry record updated Oct 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
62300 Issued in GA
Legal business name
PEACH STATE PEDIATRICS
Practice address
3001 S Cobb Dr SE
Suite 107
Smyrna, GA 30080-7874
Phone
(850) 875-3600
NPI assigned
Oct 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2012

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

Authorized official

Name
Mohammed Waris, MDNPI 1265497812
Title
Owner
Phone
(850) 270-9249

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 62300 GA Primary

Addresses

Primary practice location

3001 S Cobb Dr SE
Suite 107
Smyrna, GA 30080-7874

Mailing address

3001 S Cobb Dr SE
Suite 107
Smyrna, GA 30080-7874

National Provider Directory

National Provider Directory

Locations

3001 S Cobb Dr SE
Ste 107
Smyrna, GA 30080
Phone (770) 432-3344

Practitioners & affiliated clinicians

Practitioners 1

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": "1350345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350345600000",
    "number": "1215280177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 S COBB DR SE",
            "address_2": "SUITE 107",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300807874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 S COBB DR SE",
            "address_2": "SUITE 107",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300807874",
            "telephone_number": "850-875-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH STATE PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-16",
        "last_updated": "2012-10-16",
        "status": "A",
        "authorized_official_last_name": "WARIS",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-270-9249",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "62300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Smyrna, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; 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.