Active NPI
Derek A Fyfe, M.D.
- Pediatric Cardiology Physician
- Atlanta, GA
National Provider Identifier
1366491953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Cardiology Physician
- License
- 039103
- Practice address
- 1405 Clifton Rd
Atlanta, GA 30322 - Phone
- (404) 256-2593
- Fax
- (678) 547-1494
- NPI assigned
- May 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Cardiology Physician | 2080P0202X | 039103 | GA | Primary |
Addresses
Primary practice location
1405 Clifton Rd
Atlanta, GA 30322
Mailing address
2835 Brandywine Rd
300
Atlanta, GA 30341
Phone (770) 488-9202
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00633553A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 039103 | GA | MD | Pediatric Cardiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Childrens Healthcare of Atlanta Cardiology Inc | Pediatric Cardiology | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Cardiology Physician
- Atlanta, GA
- NPI 1235148727
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366491953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2835 BRANDYWINE RD",
"address_2": "300",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30341",
"telephone_number": "770-488-9202",
"fax_number": "678-547-1499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1405 CLIFTON RD",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30322",
"telephone_number": "404-256-2593",
"fax_number": "678-547-1494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FYFE",
"first_name": "DEREK",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0202X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Cardiology",
"state": "GA",
"license": "039103",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00633553A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.