Pediatric Center for Wellness

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

58813 Issued in GA

Legal business name

PEDIATRIC CENTER FOR WELLNESS

Practice address

1506 Klondike Rd SW Ste 205
Conyers, GA 30094-5173

Phone

(678) 750-4000

Fax

(678) 750-4005

NPI assigned

Apr 11, 2012

Organization subpart

No

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

Authorized official

Name

Chantel G Runnels, MBA

Title

Director of Operations

Phone

(678) 750-4000

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Crystal Berry Hood, M.D.

  • Pediatrics Physician
  • Conyers, GA
  • NPI 1528129251
  NPD
• Linda Linnette Payne, FNP-C

  • Family Nurse Practitioner
  • Conyers, GA
  • NPI 1407568629
  NPD
• Amirah B Johnson, M.D.

  • Pediatrics Physician
  • Dalton, GA
  • NPI 1821298480
  NPD (past)
• Heidi Sophia Gomes, M.D.

  • Pediatrics Physician
  • Plymouth, MA
  • NPI 1891765665
  NPD (past)

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

{
    "created_epoch": "1334102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714694400000",
    "number": "1437416708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1506 KLONDIKE RD SW STE 205",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300945173",
            "telephone_number": "678-750-3010",
            "fax_number": "678-750-4005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1506 KLONDIKE RD SW STE 205",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300945173",
            "telephone_number": "678-750-4000",
            "fax_number": "678-750-4005"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1015 Milstead Ave NE Ste 100",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "300124515",
            "country_code": "US",
            "telephone_number": "678-750-4000",
            "fax_number": "678-750-4005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC CENTER FOR WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-11",
        "last_updated": "2024-05-03",
        "certification_date": "2024-05-03",
        "status": "A",
        "authorized_official_last_name": "RUNNELS",
        "authorized_official_first_name": "CHANTEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "678-750-4000",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "58813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003122586A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peach Family Homecare
• Peachtree Home Health, LLC (BridgeWay Home Health)
• Kevin H Peacock, MD
• Wilerica Peagler, RBT
• Pediatric Cardiology Services LLC
• Pediatric Health Care of Conyers
• Avis W Peek, D.C.
• Pelagie Care Clinic
• Pelagie Foundation LTD (Pelagie Resource Center)
• Shazzanne Kahelia Pennant, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 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.