NPIMap

Organization Active NPI

Dahlonega Pediatric and Adolescent Medicine

Doing business as Dahlonega Pediatrics

  • Rural Health Clinic/Center
  • Dahlonega, GA
National Provider Identifier
1427333095
Registry record updated May 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
11-8910 Issued in GA
Legal business name
DAHLONEGA PEDIATRIC AND ADOLESCENT MEDICINE
Doing business as
Dahlonega Pediatrics
Practice address
1055 North Grove St.
Dahlonega, GA 30533
Phone
(706) 864-6700
Fax
(706) 864-2599
NPI assigned
Oct 14, 2011
Last updated
May 4, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2015

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

Authorized official

Name
Dr. Stephanie CornNPI 1164455481
Title
Provider/Owner
Phone
(706) 864-6700

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 11-8910 GA Primary
Pediatric Adolescent Medicine Physician 2080A0000X RN068135 GA

Addresses

Primary practice location

1055 North Grove St.
Dahlonega, GA 30533

Mailing address

1055 North Grove St
Dahlonega, GA 30533
Phone (706) 864-6700

Other identifiers 1

IdentifierTypeStateIssuer
000548369CMedicaidGA

Other names 1

  • Dahlonega Pediatrics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130624000676 GA Part A Provider - Rural Health Clinic 6608015607 Practice locations: Dahlonega, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427333095. Details of each certification follow.

Rural health clinic certification: CCN 118910

Legal name
DAHLONEGA PEDIATRIC AND ADOLESCENT MEDICINE
Doing business as
DAHLONEGA PEDIATRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 2014
Last certification
Feb 9, 2026
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Jan 13, 2004 in GA
Enrollment address
1055 North Grove Street
Dahlonega, GA 30533-3876

National Provider Directory

National Provider Directory
Tax ID family
Dahlonega Pediatric Adolescent Medicine4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1055 Grove St N
Dahlonega, GA 30533
Phone (706) 864-5362

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Margaret a Payne Individual 5% Or Greater Direct Ownership Interest Jan 13, 2004 50%
Corporate OfficerVice President Apr 1, 2004 50%
Operational/Managerial Control Apr 1, 2004
Stephanie Corn Individual 5% Or Greater Direct Ownership Interest Jan 31, 2004 50%
Corporate DirectorPresident/Director Apr 1, 2004 50%
Operational/Managerial Control Apr 1, 2004

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

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": "1318550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430697600000",
    "number": "1427333095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 NORTH GROVE ST",
            "city": "DAHLONEGA",
            "state": "GA",
            "postal_code": "30533",
            "telephone_number": "706-864-6700",
            "fax_number": "706-864-2599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 NORTH GROVE ST.",
            "city": "DAHLONEGA",
            "state": "GA",
            "postal_code": "30533",
            "telephone_number": "706-864-6700",
            "fax_number": "706-864-2599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAHLONEGA PEDIATRIC AND ADOLESCENT MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-14",
        "last_updated": "2015-05-04",
        "status": "A",
        "authorized_official_last_name": "CORN",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "706-864-6700",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "GA",
            "license": "11-8910",
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "GA",
            "license": "RN068135",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000548369C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dahlonega Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dahlonega, GA

Sources for this page

Verify at the official NPI Registry.