NPIMap

Organization Active NPI

Pediatric Cardiology Services LLC

  • Pediatric Cardiology Physician
  • Conyers, GA
National Provider Identifier
1467613232
Registry record updated Jun 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
043298 Issued in GA
Legal business name
PEDIATRIC CARDIOLOGY SERVICES LLC
Practice address
1380 Milstead Ave NE
Suite J
Conyers, GA 30012-3864
Phone
(770) 995-6684
Fax
(770) 995-7631
NPI assigned
Jun 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2008

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

Authorized official

Name
Ms. Kim Woody, RMM
Title
Practice Administrator
Phone
(770) 995-6684

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080P0202X 043298 GA Primary

Addresses

Primary practice location

1380 Milstead Ave NE
Suite J
Conyers, GA 30012-3864

Mailing address

500 Medical Center Blvd
Suite 340
Lawrenceville, GA 30045
Phone (770) 995-6684

Other identifiers 2

IdentifierTypeStateIssuer
00740891AMedicaidGA
000326873GMedicaidGA

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Cardiology Services LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

500 Medical Center Blvd
Ste 340
Lawrenceville, GA 30046
Phone (770) 813-0404

NPI Registry JSON

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1467613232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 MEDICAL CENTER BLVD",
            "address_2": "SUITE 340",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "30045",
            "telephone_number": "770-995-6684",
            "fax_number": "770-995-7631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1380 MILSTEAD AVE NE",
            "address_2": "SUITE J",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123864",
            "telephone_number": "770-995-6684",
            "fax_number": "770-995-7631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CARDIOLOGY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-24",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "WOODY",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "770-995-6684",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RMM"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "GA",
            "license": "043298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00740891A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000326873G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.