NPIMap

Organization Active NPI

Pediatric Partners of Augusta, LLC

  • Pediatrics Physician
  • Evans, GA
National Provider Identifier
1417064924
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC PARTNERS OF AUGUSTA, LLC
Practice address
411 Town Park Blvd
Evans, GA 30809-3487
Phone
(706) 854-2500
Fax
(706) 854-2559
NPI assigned
Aug 23, 2006
Last updated
Jan 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Authorized official

Name
Elizabeth Affet
Title
Practice Manger
Phone
(706) 854-2500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

411 Town Park Blvd
Evans, GA 30809-3487

Mailing address

PO Box 1758
Evans, GA 30809-1758
Phone (706) 854-2500

Other practice location 1

5135 Wrightsboro Rd Ste B
Grovetown, GA 30813-2803
Phone (706) 854-2500

Other practice location 2

1303 Dantignac St Ste 2600
Augusta, GA 30901-2796
Phone (706) 854-2500

Other identifiers 2

IdentifierTypeStateIssuer
085001130GMedicaidGA
85000031GMedicaidGA

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
11D0706472Pediatric Partners of Augusta1303 Dantignac Street Ste 2600, Augusta, GA 30901Certificate of waiverAug 12, 2026
11D0707368Pediatric Partners of Augusta LLC411 Town Park Boulevard, Evans, GA 30809ComplianceJun 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Melissa Jadick2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3665 Wheeler Rd
Ste 3B
Augusta, GA 30909

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14928/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 32

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.

View all 32

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1417064924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1758",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308091758",
            "telephone_number": "706-854-2500",
            "fax_number": "706-854-2559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 TOWN PARK BLVD",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093487",
            "telephone_number": "706-854-2500",
            "fax_number": "706-854-2559"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5135 Wrightsboro Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Grovetown",
            "state": "GA",
            "postal_code": "308132803",
            "country_code": "US",
            "telephone_number": "706-854-2500",
            "fax_number": "706-854-2559",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1303 Dantignac St Ste 2600",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309012796",
            "country_code": "US",
            "telephone_number": "706-854-2500",
            "fax_number": "706-854-2559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC PARTNERS OF AUGUSTA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "AFFET",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "PRACTICE MANGER",
        "authorized_official_telephone_number": "706-854-2500"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085001130G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "85000031G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evans, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; 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.