Decatur Pediatric Group, PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

038132 Issued in GA

Legal business name

DECATUR PEDIATRIC GROUP, PA

Practice address

4112 E Ponce de Leon Ave
Clarkston, GA 30021-1817

Phone

(404) 296-7133

Fax

(404) 296-7211

NPI assigned

Jan 18, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Lynette R Wilson-Phillips, M.D.NPI 1992769269

Title

President

Phone

(404) 296-7133

Specialties & licenses 1

Addresses

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2782/brand/1/csg/1/fhir/r4

Practitioners 1

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.

• Lynette Rochelle Wilson-Phillips, M.D.

  • Pediatrics Physician
  • Clarkston, GA
  • NPI 1992769269
  Authorized official Same address or phone

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619029592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4112 E PONCE DE LEON AVE",
            "city": "CLARKSTON",
            "state": "GA",
            "postal_code": "300211817",
            "telephone_number": "404-296-7133",
            "fax_number": "404-296-7211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4112 E PONCE DE LEON AVE",
            "city": "CLARKSTON",
            "state": "GA",
            "postal_code": "300211817",
            "telephone_number": "404-296-7133",
            "fax_number": "404-296-7211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECATUR PEDIATRIC GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILSON-PHILLIPS",
        "authorized_official_first_name": "LYNETTE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-296-7133",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "038132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Casey C Cudmore, RBT
• Emily Howell Curia, NP
• Samina A. Damani, FNP-C
• Ailaf Tesfaye Darfoor, PMHNP-BC
• Suleman Daya
• Bertukan Worku Demas
• Dental Services PC
• Melvin Dixon, CPO
• Anika Ellington
• Ethne Health

• Pediatrics Physician in Clarkston, GA
• Providers in Clarkston, GA by specialty
• Pediatrics Physician in Georgia

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.