The Kid Doctor PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

042212 Issued in GA

Legal business name

THE KID DOCTOR PC

Practice address

100 Doctors Dr
Suite 104
Douglas, GA 31533-2210

Phone

(912) 383-4352

Fax

(912) 384-1192

NPI assigned

Sep 9, 2008

Organization subpart

No

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

Authorized official

Name

Shellie Voorhees

Title

Manager

Phone

(912) 383-4352

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brian Keith Childers MD Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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

• Amanda Brulte, APRN

  • Family Nurse Practitioner
  • Douglas, GA
  • NPI 1063817872
  NPD (past)
• Kristin Margie Burnam, FNP-C

  • Family Nurse Practitioner
  • Douglas, GA
  • NPI 1801433032
  NPD (past)
• Brian Keith Childers, MD

  • Pediatrics Physician
  • Douglas, GA
  • NPI 1184675498
  NPD (past)

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

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220918400000",
    "number": "1235388786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 DOCTORS DR",
            "address_2": "SUITE 104",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332210",
            "telephone_number": "912-383-4352",
            "fax_number": "912-384-1192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 DOCTORS DR",
            "address_2": "SUITE 104",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332210",
            "telephone_number": "912-383-4352",
            "fax_number": "912-384-1192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE KID DOCTOR PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-09",
        "last_updated": "2008-09-09",
        "status": "A",
        "authorized_official_last_name": "VOORHEES",
        "authorized_official_first_name": "SHELLIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "912-383-4352"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "042212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000718792E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brian Keith Childers MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tories Taylor
• Taylormade by Tori T
• Tender Care, Inc.
• Gregory M Thackston, DMD
• Laura L Tharp, M.D.
• The Medicine Cabinet - Ward Street, LLC
• The Medicine Cabinet of Douglas, LLC
• The Speech & Swallowing Clinic, LLC
• The Therapy Tree for Pediatrics, LLC
• The Therapy Tree of Georgia LLC

• Pediatrics Physician in Douglas, GA
• Providers in Douglas, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2008; 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.