NPIMap

Organization Active NPI

Jefferson Pediatrics, Inc.

  • Primary Care Clinic/Center
  • Jefferson, GA
National Provider Identifier
1336411347
Registry record updated Feb 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
038372 Issued in GA
Legal business name
JEFFERSON PEDIATRICS, INC.
Practice address
2610 Highway 129 N
Jefferson, GA 30549-2652
Phone
(706) 367-1010
NPI assigned
Feb 7, 2012
Last updated
Feb 7, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2012

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

Authorized official

Name
Tammy Gail Smith, M.D.NPI 1740382894
Title
Officer
Phone
(706) 367-1010

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 038372 GA Primary

Addresses

Primary practice location

2610 Highway 129 N
Jefferson, GA 30549-2652

Mailing address

2610 Highway 129 N
Jefferson, GA 30549-2652
Phone (706) 367-1010

Other identifiers 3

IdentifierTypeStateIssuer
10055116OtherGAAMERIGROUP
309153OtherGAWELLCARE
00608253HMedicaidGA

National Provider Directory

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": "1328572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328572800000",
    "number": "1336411347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2610 HIGHWAY 129 N",
            "city": "JEFFERSON",
            "state": "GA",
            "postal_code": "305492652",
            "telephone_number": "706-367-1010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2610 HIGHWAY 129 N",
            "city": "JEFFERSON",
            "state": "GA",
            "postal_code": "305492652",
            "telephone_number": "706-367-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON PEDIATRICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-07",
        "last_updated": "2012-02-07",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "GAIL",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "706-367-1010",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "038372",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10055116",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "309153",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00608253H",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 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.