Active NPI
Marilyn B Kaufman, M.D.
- Pediatrics Physician
- Douglasville, GA
National Provider Identifier
1407846744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 32217
- Practice address
- 6095 Professional Parkway
Suite 100
Douglasville, GA 30134 - Phone
- (770) 920-2255
- Fax
- (770) 920-9963
- NPI assigned
- Oct 27, 2005
- Last updated
- Aug 7, 2012
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 32217 | GA | Primary |
Addresses
Primary practice location
6095 Professional Parkway
Suite 100
Douglasville, GA 30134
Mailing address
6095 Professional Parkway
Suite 100
Douglasville, GA 30134
Phone (770) 920-2255
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 |
|---|---|---|---|
| 32217 | GA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellstar Health System, Inc. | Pediatrics | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344297600000",
"number": "1407846744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6095 PROFESSIONAL PARKWAY",
"address_2": "SUITE 100",
"city": "DOUGLASVILLE",
"state": "GA",
"postal_code": "30134",
"telephone_number": "770-920-2255",
"fax_number": "770-920-9963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6095 PROFESSIONAL PARKWAY",
"address_2": "SUITE 100",
"city": "DOUGLASVILLE",
"state": "GA",
"postal_code": "30134",
"telephone_number": "770-920-2255",
"fax_number": "770-920-9963"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAUFMAN",
"first_name": "MARILYN",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-27",
"last_updated": "2012-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "32217",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Douglasville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.