NPIMap

Organization Active NPI

Westcare Villa Rica Pediatrics

  • Pediatrics Physician
  • Villa Rica, GA
National Provider Identifier
1487742532
Registry record updated May 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
WESTCARE VILLA RICA PEDIATRICS
Practice address
626 Dallas Hwy
Villa Rica, GA 30180-1209
Phone
(770) 459-9378
Fax
(770) 459-8613
NPI assigned
Oct 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2012

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

Authorized official

Name
Amanda Maxwell
Title
Office Manager
Phone
(770) 832-2005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

626 Dallas Hwy
Villa Rica, GA 30180-1209

Mailing address

626 Dallas Hwy
Villa Rica, GA 30180-1209
Phone (770) 459-9378

Other identifiers 1

IdentifierTypeStateIssuer
203686572AOtherGAMEDICAID PAYEE NUMBER

Other names 1

  • Westcare Pediatrics and Adult Medicine Doing business as

National Provider Directory

National Provider Directory

Locations

205 Bankhead Hwy
Carrollton, GA 30117
Phone (770) 832-2005

626 Dallas Hwy
Villa Rica, GA 30180
Phone (770) 459-9378

626 Dallas Hwy
Fl 1
Villa Rica, GA 30180

Practitioners & affiliated clinicians

Practitioners 7

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": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337040000000",
    "number": "1487742532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 DALLAS HWY",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801209",
            "telephone_number": "770-459-9378",
            "fax_number": "770-459-8613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 DALLAS HWY",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801209",
            "telephone_number": "770-459-9378",
            "fax_number": "770-459-8613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTCARE VILLA RICA PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2012-05-15",
        "status": "A",
        "authorized_official_last_name": "MAXWELL",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-832-2005"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PAYEE NUMBER",
            "identifier": "203686572A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westcare Pediatrics and Adult Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Villa Rica, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2012; 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.