NPIMap

Organization Active NPI

Lakeside Pediatrics, LLC

  • Pediatrics Physician
  • Cumming, GA
National Provider Identifier
1326317520
Registry record updated Dec 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
040865 Issued in GA
Legal business name
LAKESIDE PEDIATRICS, LLC
Practice address
204 Canton Rd
Cumming, GA 30040-2304
Phone
(770) 886-5437
Fax
(770) 886-9717
NPI assigned
Dec 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2011

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

Authorized official

Name
Bob B Bagheri, M.D.NPI 1326017906
Title
President
Phone
(770) 886-5437

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X 040865 GA Primary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X 050209 GA

Addresses

Primary practice location

204 Canton Rd
Cumming, GA 30040-2304

Mailing address

11565 Mountain Laurel Dr
Roswell, GA 30075-1333
Phone (770) 886-5437

National Provider Directory

National Provider Directory

Locations

204 Canton Rd
Cumming, GA 30040
Phone (770) 886-5437

Practitioners & affiliated clinicians

Practitioners 4

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": "1324252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324252800000",
    "number": "1326317520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11565 MOUNTAIN LAUREL DR",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300751333",
            "telephone_number": "770-886-5437",
            "fax_number": "770-886-9717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 CANTON RD",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300402304",
            "telephone_number": "770-886-5437",
            "fax_number": "770-886-9717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-19",
        "last_updated": "2011-12-19",
        "status": "A",
        "authorized_official_last_name": "BAGHERI",
        "authorized_official_first_name": "BOB",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-886-5437",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "040865",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "050209",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; 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.