NPIMap

Organization Active NPI

DV Pediatrics LLC

  • Primary Care Clinic/Center
  • Canton, GA
National Provider Identifier
1346368149
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
047337 Issued in GA
Legal business name
DV PEDIATRICS LLC
Practice address
2920 Marietta Hwy
Suite 142
Canton, GA 30114-8212
Phone
(770) 704-0057
Fax
(770) 704-0223
NPI assigned
Mar 27, 2007
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
Dr. Vicki D Knight-Mathis, M.D.NPI 1013916212
Title
Owner
Phone
(770) 704-0057

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
Primary Care Clinic/Center 261QP2300X 047337 GA Primary

Addresses

Primary practice location

2920 Marietta Hwy
Suite 142
Canton, GA 30114-8212

Mailing address

2920 Marietta Hwy
Suite 142
Canton, GA 30114-8212
Phone (770) 704-0057

National Provider Directory

National Provider Directory

Locations

2920 Marietta Hwy
Ste 142
Canton, GA 30114
Phone (770) 704-0057

Practitioners & affiliated clinicians

Practitioners 3

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": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346368149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 MARIETTA HWY",
            "address_2": "SUITE 142",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301148212",
            "telephone_number": "770-704-0057",
            "fax_number": "770-704-0223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 MARIETTA HWY",
            "address_2": "SUITE 142",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301148212",
            "telephone_number": "770-704-0057",
            "fax_number": "770-704-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DV PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KNIGHT-MATHIS",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-704-0057",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "047337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.