NPIMap

Organization Active NPI

Intown Pediatric and Adolescent Medicine

  • Pediatrics Physician
  • Atlanta, GA
National Provider Identifier
1457375073
Registry record updated Nov 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
058200 Issued in GA
Legal business name
INTOWN PEDIATRIC AND ADOLESCENT MEDICINE
Practice address
490 Bill Kennedy Way SE
Suite 101
Atlanta, GA 30316-6835
Phone
(404) 446-4726
Fax
(404) 446-4727
NPI assigned
Jul 27, 2006
Last updated
Nov 22, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2011

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

Authorized official

Name
Deneta H Sells, M.D.NPI 1114982998
Title
President
Phone
(404) 446-4726

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 058200 GA Primary

Addresses

Primary practice location

490 Bill Kennedy Way SE
Suite 101
Atlanta, GA 30316-6835

Mailing address

490 Bill Kennedy Way SE
Suite 101
Atlanta, GA 30316-6835
Phone (404) 446-4726

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210819002891 GA Part B Supplier - Mass Immunization (Roster Biller Only) 4587069190 Practice locations: Atlanta, GA

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
11D1058502Intown Pediatric and Adolescent Medicine PC490 Bill Kennedy Way, Suite 101, Atlanta, GA 30316Certificate of waiverAug 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
Intown Pediatric Adlsnt Med2 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

490 Bill Kennedy Way SE
Atlanta, GA 30316
Phone (404) 446-4726

705 Town Blvd NE
Ste S560
Brookhaven, GA 30319
Phone (404) 446-4726

200 E Ponce de Leon Ave
Ste 150
Decatur, GA 30030
Phone (706) 980-2518

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321920000000",
    "number": "1457375073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "490 BILL KENNEDY WAY SE",
            "address_2": "SUITE 101",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303166835",
            "telephone_number": "404-446-4726",
            "fax_number": "404-446-4727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 BILL KENNEDY WAY SE",
            "address_2": "SUITE 101",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303166835",
            "telephone_number": "404-446-4726",
            "fax_number": "404-446-4727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTOWN PEDIATRIC AND ADOLESCENT MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2011-11-22",
        "status": "A",
        "authorized_official_last_name": "SELLS",
        "authorized_official_first_name": "DENETA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-446-4726",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "058200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.