The Pediatric Office, LLC

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

Legal business name

THE PEDIATRIC OFFICE, LLC

Practice address

4321 University Pkwy
Suite 104
Evans, GA 30809-3058

Phone

(706) 854-2600

Fax

(706) 854-2601

NPI assigned

May 27, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Keelyn Clark Cunningham

Title

Office Manager

Phone

(706) 854-2600

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Deepa Sanjay Jagdale, M.D.

  • Pediatrics Physician
  • Martinez, GA
  • NPI 1447412184

  GA

  Medicare reassignment NPD
• Margaret McGee Renew, MD

  • Pediatric Adolescent Medicine Physician
  • Evans, GA
  • NPI 1699759688

  Adolescent Medicine, GA

  Medicare reassignment NPD

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225843200000",
    "number": "1629025432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4321 UNIVERSITY PKWY",
            "address_2": "SUITE 104",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093058",
            "telephone_number": "706-854-2600",
            "fax_number": "706-854-2601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4321 UNIVERSITY PKWY",
            "address_2": "SUITE 104",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093058",
            "telephone_number": "706-854-2600",
            "fax_number": "706-854-2601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PEDIATRIC OFFICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2008-11-05",
        "status": "A",
        "authorized_official_last_name": "CUNNINGHAM",
        "authorized_official_first_name": "KEELYN",
        "authorized_official_middle_name": "CLARK",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "706-854-2600",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300035984A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Georgia Center for Dermatology and Skin Cancer Specialists
• The Georgia Center for Facial Plastic Surgery and Laser Aesthetics
• The Kroger Co
• The Legacy Dental Group, LLC
• The Nexus Pain Center of Augusta LLC
• The Therapy Loft, LLC
• The Wilkers Group, LLC
• Therapy Trails of Evans
• Cassidy Nicole Thigpen, MS
• Patrick Maurice Thomae, D.O.

• All providers in Evans, GA
• Pediatric Adolescent Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.