NPIMap

Organization Active NPI

Wellstar Medical Group East Paulding Pediatrics

  • Specialist
  • Hiram, GA
National Provider Identifier
1396738381
Registry record updated Dec 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
024912 Issued in LA
Legal business name
WELLSTAR MEDICAL GROUP EAST PAULDING PEDIATRICS
Practice address
51 Hiram Dr
Hiram, GA 30141-1844
Phone
(678) 945-8300
Fax
(770) 445-2020
NPI assigned
Aug 25, 2005
Last updated
Dec 8, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
WELLSTAR MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 8, 2011

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

Authorized official

Name
Dr. Kelly Davillier, MD
Title
Physician
Phone
(678) 945-8320

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 024912 LA Primary

Addresses

Primary practice location

51 Hiram Dr
Hiram, GA 30141-1844

Mailing address

51 Hiram Dr
Hiram, GA 30141-1844
Phone (678) 945-8300

Other identifiers 2

IdentifierTypeStateIssuer
1420565MedicaidLA
1899964650AMedicaidGA

National Provider Directory

National Provider Directory
Tax ID family
Pulmonary Wellstar125 organizations share this tax ID, including this one
Part of
Pulmonary Wellstar

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

51 Hiram Dr
Hiram, GA 30141
Phone (678) 945-8300

Practitioners & affiliated clinicians

Practitioners 2

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": "1124928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323302400000",
    "number": "1396738381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 HIRAM DR",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301411844",
            "telephone_number": "678-945-8300",
            "fax_number": "770-445-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 HIRAM DR",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301411844",
            "telephone_number": "678-945-8300",
            "fax_number": "770-445-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP EAST PAULDING PEDIATRICS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP",
        "enumeration_date": "2005-08-25",
        "last_updated": "2011-12-08",
        "status": "A",
        "authorized_official_last_name": "DAVILLIER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "678-945-8320",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "LA",
            "license": "024912",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1420565",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1899964650A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hiram, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 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.