NPIMap

Organization Active NPI

Pediatria Healthcare, LLC

  • Medically Fragile Infants and Children Day Care
  • Tucker, GA
National Provider Identifier
1457539090
Registry record updated May 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medically Fragile Infants and Children Day CareTaxonomy code 261QM3000X
License
CCLC-18589 Issued in GA
Legal business name
PEDIATRIA HEALTHCARE, LLC
Practice address
1967 Lakeside Pkwy
Suite 420
Tucker, GA 30084-5867
Phone
(770) 414-0055
Fax
(770) 414-0045
NPI assigned
Feb 6, 2008
Organization subpart
Yes
Parent organization
PEDIATRIA HEALTHCARE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 22, 2008

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

Authorized official

Name
Ms. Robbie Kilinski
Title
VP of Business Operations
Phone
(770) 840-1966

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medically Fragile Infants and Children Day Care 261QM3000X CCLC-18589 GA Primary

Addresses

Primary practice location

1967 Lakeside Pkwy
Suite 420
Tucker, GA 30084-5867

Mailing address

5185 Peachtree Pkwy
Ste 350
Norcross, GA 30092-6542
Phone (770) 840-1966

Other identifiers 1

IdentifierTypeStateIssuer
656991060BMedicaidGA

National Provider Directory

National Provider Directory
Tax ID family
Pediatria Healthcare LLC26 organizations share this tax ID, including this one
Part of
Pediatria Healthcare LLC

Other organizations with this tax ID 25

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

View all 25

Locations

1967 Lakeside Pkwy
Ste 420
Tucker, GA 30084
Phone (770) 414-0055

2935 N Ashley St
Ste 103
Valdosta, GA 31602
Phone (229) 316-1102

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211414400000",
    "number": "1457539090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5185 PEACHTREE PKWY",
            "address_2": "STE 350",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300926542",
            "telephone_number": "770-840-1966",
            "fax_number": "770-840-1901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1967 LAKESIDE PKWY",
            "address_2": "SUITE 420",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300845867",
            "telephone_number": "770-414-0055",
            "fax_number": "770-414-0045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIA HEALTHCARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIA HEALTHCARE, LLC",
        "enumeration_date": "2008-02-06",
        "last_updated": "2008-05-22",
        "status": "A",
        "authorized_official_last_name": "KILINSKI",
        "authorized_official_first_name": "ROBBIE",
        "authorized_official_title_or_position": "VP OF BUSINESS OPERATIONS",
        "authorized_official_telephone_number": "770-840-1966",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM3000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medically Fragile Infants and Children Day Care",
            "state": "GA",
            "license": "CCLC-18589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "656991060B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucker, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; 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.