Kids Time Pediatrics of Southern Crescent, LLC

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

Legal business name

KIDS TIME PEDIATRICS OF SOUTHERN CRESCENT, LLC

Practice address

115 Sumner Rd
Suite D
Fayetteville, GA 30214-4758

Phone

(706) 342-2180

NPI assigned

Mar 13, 2007

Organization subpart

No

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

Authorized official

Name

Flynn Clyburn

Title

President

Phone

(706) 342-2180

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447383351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "696 BILLUPS AVE",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "306501439",
            "telephone_number": "706-342-2180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 SUMNER RD",
            "address_2": "SUITE D",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144758",
            "telephone_number": "706-342-2180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS TIME PEDIATRICS OF SOUTHERN CRESCENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLYBURN",
        "authorized_official_first_name": "FLYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-342-2180"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Niraj Khandelwal, MD, MHS
• Shyam L Khanwani, MD
• Khudsonandcbarberdmdpc
• Kids Making Connections, LLC
• Kids Medical Therapies Inc.
• Brett Joseph Kieffer, AA-S
• Thomas Matthew Kilgore, DPT
• Elizabeth W Killebrew, MD
• John W Kim, DMD
• Rasheeda Kimbro

• Pediatric Adolescent Medicine Physician in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Pediatric Adolescent Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.