NPIMap

Organization Active NPI

Pediatric Physicians, P.C.

  • Primary Care Clinic/Center
  • Roswell, GA
National Provider Identifier
1285768184
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PEDIATRIC PHYSICIANS, P.C.
Practice address
11050 Crabapple Rd
Suite 120
Roswell, GA 30075-2489
Phone
(770) 518-9277
Fax
(770) 518-8718
NPI assigned
Mar 15, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jose De Urioste
Title
Business Manager
Phone
(770) 518-9277

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

11050 Crabapple Rd
Suite 120
Roswell, GA 30075-2489

Mailing address

11050 Crabapple Rd
Suite 120
Roswell, GA 30075-2489
Phone (770) 518-9277

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
11D1025627Pediatric Physician PC11050 Crabapple Road, Suite 120, Roswell, GA 30075Certificate of waiverMay 11, 2028

National Provider Directory

National Provider Directory

Locations

11050 Crabapple Rd
Bldg D12
Roswell, GA 30075

11050 Crabapple Rd
Ste 120
Roswell, GA 30075
Phone (770) 518-9277

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285768184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11050 CRABAPPLE RD",
            "address_2": "SUITE 120",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300752489",
            "telephone_number": "770-518-9277",
            "fax_number": "770-518-8718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 CRABAPPLE RD",
            "address_2": "SUITE 120",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300752489",
            "telephone_number": "770-518-9277",
            "fax_number": "770-518-8718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PHYSICIANS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DE URIOSTE",
        "authorized_official_first_name": "JOSE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "770-518-9277"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.