NPIMap

Organization Active NPI

Egleston Pedatric Group

  • Pediatrics Physician
  • Duluth, GA
National Provider Identifier
1558415232
Registry record updated Apr 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
EGLESTON PEDATRIC GROUP
Practice address
2620 Satellite Blvd
Duluth, GA 30096-1204
Phone
(404) 785-8000
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2023

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

Authorized official

Name
Louetta Cody
Title
Manager, Provider Enrollment
Phone
(404) 785-7876

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

2620 Satellite Blvd
Duluth, GA 30096-1204

Mailing address

1584 Tullie Cir NE
Atlanta, GA 30329-2311
Phone (404) 785-7928

National Provider Directory

National Provider Directory
Tax ID family
Children'S Healthcare of Atlanta at Mount Zion7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680480000000",
    "number": "1558415232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1584 TULLIE CIR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292311",
            "telephone_number": "404-785-7928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 SATELLITE BLVD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300961204",
            "telephone_number": "404-785-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EGLESTON PEDATRIC GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2023-04-03",
        "certification_date": "2023-04-03",
        "status": "A",
        "authorized_official_last_name": "CODY",
        "authorized_official_first_name": "LOUETTA",
        "authorized_official_title_or_position": "MANAGER, PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "404-785-7876"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2023; 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.