NPIMap

Organization Active NPI

Peachtree Pediatrics, PLLC

  • Pediatrics Physician
  • Murphy, NC
National Provider Identifier
1487782942
Registry record updated Sep 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEACHTREE PEDIATRICS, PLLC
Practice address
125 Medical Park LN
Suite F
Murphy, NC 28906-6920
Phone
(828) 837-2128
Fax
(828) 837-6244
NPI assigned
Feb 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2016

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

Authorized official

Name
Kathryn Gibson Waggoner, D.O.NPI 1881704195
Title
Owner
Phone
(828) 837-2128

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
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

125 Medical Park LN
Suite F
Murphy, NC 28906-6920

Mailing address

125 Medical Park LN
Suite F
Murphy, NC 28906-6920
Phone (828) 837-2128

Other identifiers 1

IdentifierTypeStateIssuer
89012C7MedicaidNC

Other names 1

  • Peachtree Pediatric Clinic, P.A. Former legal business name

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
34D0248520Peachtree Pediatric PLLC125 Medical Park Lane Suie H, Murphy, NC 28906Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473638400000",
    "number": "1487782942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 MEDICAL PARK LN",
            "address_2": "SUITE F",
            "city": "MURPHY",
            "state": "NC",
            "postal_code": "289066920",
            "telephone_number": "828-837-2128",
            "fax_number": "828-837-6244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 MEDICAL PARK LN",
            "address_2": "SUITE F",
            "city": "MURPHY",
            "state": "NC",
            "postal_code": "289066920",
            "telephone_number": "828-837-2128",
            "fax_number": "828-837-6244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE PEDIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2016-09-12",
        "status": "A",
        "authorized_official_last_name": "WAGGONER",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "GIBSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "828-837-2128",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89012C7",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peachtree Pediatric Clinic, P.A.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Murphy, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2016; 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.