NPIMap

Organization Active NPI

Gwendolyn a. Delaney, M.D. LLC

Doing business as Vickery Pediatrics and Adolescent Medicine

  • Pediatric Adolescent Medicine Physician
  • Cumming, GA
National Provider Identifier
1639297401
Registry record updated Jan 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
049380 Issued in GA
Legal business name
GWENDOLYN A. DELANEY, M.D. LLC
Doing business as
Vickery Pediatrics and Adolescent Medicine
Practice address
410 Peachtree Pkwy Ste 4260
Cumming, GA 30041-7407
Phone
(678) 990-2501
Fax
(678) 990-2505
NPI assigned
Mar 27, 2007
Last updated
Jan 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2020

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

Authorized official

Name
Gwendolyn A DelaneyNPI 1720085012
Title
Managing Member
Phone
(678) 990-2501

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2080A0000X 049380 GA Primary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2080A0000X 051519 GA

Addresses

Primary practice location

410 Peachtree Pkwy Ste 4260
Cumming, GA 30041-7407

Mailing address

410 Peachtree Pkwy Ste 4260
Cumming, GA 30041-7407
Phone (678) 990-2501

Other identifiers 1

IdentifierTypeStateIssuer
000885431QMedicaidGA

Other names 1

  • VICKERY PEDIATRICS AND ADOLESCENT MEDICINE Doing business as

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
11D1043236Vickery Pediatrics, LLC410 Peachtree Parkway, Suite 4260, Cumming, GA 30041Certificate of waiverJun 24, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578960000000",
    "number": "1639297401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 PEACHTREE PKWY STE 4260",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417407",
            "telephone_number": "678-990-2501",
            "fax_number": "678-990-2505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 PEACHTREE PKWY STE 4260",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417407",
            "telephone_number": "678-990-2501",
            "fax_number": "678-990-2505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWENDOLYN A. DELANEY, M.D. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2020-01-14",
        "certification_date": "2020-01-14",
        "status": "A",
        "authorized_official_last_name": "DELANEY",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "678-990-2501"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "GA",
            "license": "049380",
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "GA",
            "license": "051519",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000885431Q",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VICKERY PEDIATRICS AND ADOLESCENT MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "VICKERY PEDIATRICS AND ADOLESCENT MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cumming, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 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.