NPIMap

Organization Active NPI

Pediatric Associates of Johns Creek PC

  • Pediatrics Physician
  • Suwanee, GA
National Provider Identifier
1578685384
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC ASSOCIATES OF JOHNS CREEK PC
Practice address
4310 Johns Creek Pkwy
Ste 150
Suwanee, GA 30024-6091
Phone
(770) 476-4020
Fax
(770) 476-1674
NPI assigned
Apr 4, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Stacy Cragg
Title
Office Manager
Phone
(770) 476-4020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

4310 Johns Creek Pkwy
Ste 150
Suwanee, GA 30024-6091

Mailing address

4310 Johns Creek Pkwy
Ste 150
Suwanee, GA 30024-6091
Phone (770) 476-4020

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
11D0967013Pediatric Associates of Johns Creek PC4310 Johns Creek Parkway, Suite 150, Suwanee, GA 30024ComplianceDec 15, 2027

National Provider Directory

National Provider Directory

Locations

4310 Johns Creek Pkwy
Ste 150
Suwanee, GA 30024
Phone (770) 476-4020

Practitioners & affiliated clinicians

Practitioners 10

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": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1578685384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 JOHNS CREEK PKWY",
            "address_2": "STE 150",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246091",
            "telephone_number": "770-476-4020",
            "fax_number": "770-476-1674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 JOHNS CREEK PKWY",
            "address_2": "STE 150",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246091",
            "telephone_number": "770-476-4020",
            "fax_number": "770-476-1674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES OF JOHNS CREEK PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CRAGG",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-476-4020"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suwanee, 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.
  • 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.