Active NPI
Black's Pediatric Therapy, Inc.
- Pediatric Occupational Therapist
- Gainesville, GA
National Provider Identifier
1477754067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 003199
- Legal business name
- BLACK'S PEDIATRIC THERAPY, INC.
- Practice address
- 4502 Summer Gate CT.
Gainesville, GA 30506 - Phone
- (770) 378-5986
- NPI assigned
- May 30, 2007
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Tina Black
- Title
- Owner
- Phone
- (770) 378-5986
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 003199 | GA | Primary |
Addresses
Primary practice location
4502 Summer Gate CT.
Gainesville, GA 30506
Mailing address
4502 Summer Gate CT.
Gainesville, GA 30506
Phone (770) 378-5986
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10038361 | Other | GA | AMERIGROUP- TINA |
| 307327 | Other | GA | TINA- WELLCARE |
| 10047944 | Other | GA | AMERIGROUP-BETH CHAMBERS |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180483200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1477754067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4502 SUMMER GATE CT.",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "30506",
"telephone_number": "770-378-5986"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4502 SUMMER GATE CT.",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "30506",
"telephone_number": "770-378-5986"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BLACK'S PEDIATRIC THERAPY, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-30",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "BLACK",
"authorized_official_first_name": "TINA",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "770-378-5986"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapist, Pediatrics",
"state": "GA",
"license": "003199",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP- TINA",
"identifier": "10038361",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TINA- WELLCARE",
"identifier": "307327",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP-BETH CHAMBERS",
"identifier": "10047944",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, GA
Sources for this page
- 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.