NPIMap

Organization Active NPI

Primary Pediatrics, PC

  • Specialist
  • Macon, GA
National Provider Identifier
1477638575
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PRIMARY PEDIATRICS, PC
Practice address
5300 Bowman Rd
Macon, GA 31210
Phone
(478) 741-3007
Fax
(478) 200-1960
NPI assigned
Oct 26, 2006
Last updated
Apr 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

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

Authorized official

Name
Lance Slade, MDNPI 1699858514
Title
President
Phone
(478) 741-3007

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
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

5300 Bowman Rd
Macon, GA 31210

Mailing address

5300 Bowman Rd
Macon, GA 31210
Phone (478) 741-3007

Other identifiers 2

IdentifierTypeStateIssuer
300034047AMedicaidGA
003216177AMedicaidGA

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
11D0264038Primary Pediatrics of Macon5300 Bowman Road, Macon, GA 31210ComplianceJun 29, 2026

National Provider Directory

National Provider Directory

Locations

104 Bluff Chase
Ste A
Bonaire, GA 31005

230 Industrial Blvd
Ste D
Dublin, GA 31021
Phone (478) 272-1366

230 Industrial Blvd
Ste E
Dublin, GA 31021

164 N Lee St
Forsyth, GA 31029

146 Sylvan Dr
Jackson, GA 30233
Phone (770) 775-1300

5300 Bowman Park
Macon, GA 31210
Phone (478) 741-3007

550 Professional Dr
Macon, GA 31201
Phone (478) 741-3007

110 Regency Park Dr
Ste A
McDonough, GA 30253
Phone (770) 320-7023

6082 Lakeview Rd
Warner Robins, GA 31088

Practitioners & affiliated clinicians

Practitioners 45

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 45

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744156800000",
    "number": "1477638575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 BOWMAN RD",
            "city": "MACON",
            "state": "GA",
            "postal_code": "31210",
            "telephone_number": "478-741-3007",
            "fax_number": "478-200-1960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 BOWMAN RD",
            "city": "MACON",
            "state": "GA",
            "postal_code": "31210",
            "telephone_number": "478-741-3007",
            "fax_number": "478-200-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY PEDIATRICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2025-04-09",
        "status": "A",
        "authorized_official_last_name": "SLADE",
        "authorized_official_first_name": "LANCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "478-741-3007",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300034047A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003216177A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2025; 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.