Alexander Taro Iwamoto, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

92011 Issued in GA

Practice address

1875 Century Blvd NE Ste 150
Atlanta, GA 30345-3323

Phone

(404) 633-4595

NPI assigned

Mar 18, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Childfren'S Medical Group, P.C.

  • Pediatric Adolescent Medicine Physician
  • Atlanta, GA
  • NPI 1497865935
  NPD (past)
• Edward M. Gotlieb, M.D., Et Al Dba the Pediatric Center

  • Pediatrics Physician
  • Stone Mountain, GA
  • NPI 1619197498
  NPD (past)

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

{
    "created_epoch": "1552867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1417416611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 CENTURY BLVD NE STE 150",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303453323",
            "telephone_number": "404-633-4595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 CENTURY BLVD NE STE 150",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303453323",
            "telephone_number": "404-633-4595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IWAMOTO",
        "first_name": "ALEXANDER",
        "middle_name": "TARO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-18",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "92011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Ivler, LICSW
• Chinedu Ivonye, MD
• Leslie Ivory, C.S.A
• Tyler Marie Ivory, MD
• Deja Ivy, MS, RD , LD
• Sally Williams Iwamoto, M.D.
• Isabella Iwanicki
• Todd William Iwanicki, MD
• Kathryn Iwasaki, PA-C
• Kingsley Iwudibia, PHARMD

• Pediatrics Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.