Judith A Anderson, MD – Pediatrics Physician

Key facts

NPI: 1619213378
Entity type: Individual (NPI type 1)
Primary specialty: Pediatrics Physician 208000000X
License: 074892 (GA)
Practice address: 611 East Villanow Street
La Fayette, GA 30728
Phone: (706) 638-1606
Fax: (706) 638-9907
NPI assigned: Dec 27, 2012
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Dr. Miniyars Pediatrics, P.C. Pediatrics Physician · Rome, GA · NPI 1760651806

NPD (past) PEDIATRICS

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
074892	GA	MD	Pediatrics Physician
26779	TN	MD	Pediatrics Physician

Practice roles

Organization	Specialty	Status	New patients
Dr. Miniyars Pediatrics, P.C.	Pediatrics	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pediatrics Physician	208000000X	26779	TN
Pediatrics Physician	208000000X	074892	GA	Yes

Addresses

Primary practice location

611 East Villanow Street
La Fayette, GA 30728

Mailing address

611 East Villanow Street
La Fayette, GA 30728
Phone (706) 638-1606

Other providers in La Fayette, GA

All providers in La Fayette, GA · Pediatrics Physician in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2015. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.