NPIMap

Organization Active NPI

Northlake Pediatric Associates,PC

  • Pediatrics Physician
  • Stone Mountain, GA
National Provider Identifier
1518174036
Registry record updated Jan 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
NORTHLAKE PEDIATRIC ASSOCIATES,PC
Practice address
1805 Parke Plaza Cir
Suite 103
Stone Mountain, GA 30087-3498
Phone
(770) 498-9355
Fax
(770) 498-6294
NPI assigned
May 16, 2007
Last updated
Jan 8, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2014

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

Authorized official

Name
Mrs. Delores Taliaferro
Title
Office Manager
Phone
(770) 498-9355

Specialties & licenses 1

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

Addresses

Primary practice location

1805 Parke Plaza Cir
Suite 103
Stone Mountain, GA 30087-3498

Mailing address

1805 Parke Plaza Cir
Suite 103
Stone Mountain, GA 30087-3498
Phone (770) 498-9355

Other identifiers 1

IdentifierTypeStateIssuer
85000926GMedicaidGA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389139200000",
    "number": "1518174036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 PARKE PLAZA CIR",
            "address_2": "SUITE 103",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873498",
            "telephone_number": "770-498-9355",
            "fax_number": "770-498-6294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 PARKE PLAZA CIR",
            "address_2": "SUITE 103",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873498",
            "telephone_number": "770-498-9355",
            "fax_number": "770-498-6294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAKE PEDIATRIC ASSOCIATES,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2014-01-08",
        "status": "A",
        "authorized_official_last_name": "TALIAFERRO",
        "authorized_official_first_name": "DELORES",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-498-9355",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "85000926G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stone Mountain, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; 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.