NPIMap

Organization Active NPI

Dekalb Pediatric Associates PC

Doing business as Health care

  • Pediatrics Physician
  • Tucker, GA
National Provider Identifier
1376829911
Registry record updated Oct 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
050105 Issued in GA
Legal business name
DEKALB PEDIATRIC ASSOCIATES PC
Doing business as
Health care
Practice address
1390 Montreal Rd Ste 180
Tucker, GA 30084-8187
Phone
(404) 446-4600
Fax
(404) 446-4601
NPI assigned
Oct 27, 2011
Organization subpart
Yes
Parent organization
DEKALB PEDIATRIC ASSOCIATES PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 27, 2011

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

Authorized official

Name
Dr. Ronald A Homer, MDNPI 1124072822
Title
Ceo
Phone
(404) 446-4600

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
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 050105 GA Primary

Addresses

Primary practice location

1390 Montreal Rd Ste 180
Tucker, GA 30084-8187

Mailing address

1390 Montreal Rd Ste 180
Tucker, GA 30084-8187
Phone (404) 446-4600

Other identifiers 1

IdentifierTypeStateIssuer
000940266KMedicaidGA

Other names 1

  • Health care Doing business as

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
11D1049187Dekalb Pediatric Associates PC1390 Montreal Road Suite 180, Tucker, GA 30084Certificate of waiverJun 13, 2027

National Provider Directory

National Provider Directory
Part of
Dekalb Pediatric Associates PC

Locations

1390 Montreal Rd
Ste 180
Tucker, GA 30084
Phone (404) 446-4600

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FCBBAA

Practitioners & affiliated clinicians

Practitioners 4

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": "1319673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319673600000",
    "number": "1376829911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1390 MONTREAL RD STE 180",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300848187",
            "telephone_number": "404-446-4600",
            "fax_number": "404-446-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1390 MONTREAL RD STE 180",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300848187",
            "telephone_number": "404-446-4600",
            "fax_number": "404-446-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEKALB PEDIATRIC ASSOCIATES PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEKALB PEDIATRIC ASSOCIATES PC",
        "enumeration_date": "2011-10-27",
        "last_updated": "2011-10-27",
        "status": "A",
        "authorized_official_last_name": "HOMER",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-446-4600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "050105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000940266K",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucker, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; 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.