NPIMap

Organization Active NPI

Pediatric Services of America, LLC

Doing business as Aveanna Heatlhcare

  • Nursing Care Agency
  • Stockbridge, GA
National Provider Identifier
1639467327
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Care AgencyTaxonomy code 251J00000X
License
106-R-0941 Issued in GA
Legal business name
PEDIATRIC SERVICES OF AMERICA, LLC
Doing business as
Aveanna Heatlhcare
Practice address
225 Country Club Dr Ste 240
Stockbridge, GA 30281-7339
Phone
(770) 810-6922
Fax
(770) 810-6930
NPI assigned
Jul 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Authorized official

Name
Matthew Buckhalter
Title
Cfo
Phone
(470) 464-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X 106-R-0941 GA Primary

Addresses

Primary practice location

225 Country Club Dr Ste 240
Stockbridge, GA 30281-7339

Mailing address

400 Interstate North Pkwy SE Ste 1600
Atlanta, GA 30339-5047
Phone (470) 464-8000

Other identifiers 1

IdentifierTypeStateIssuer
675782530BMedicaidGA

Other names 1

  • Aveanna Heatlhcare 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
11D2031121Pediatric Services of America, LLC225 Country Club Drive, Suite 240, Stockbridge, GA 30281Certificate of waiverOct 12, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Services of76 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 9

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

225 Country Club Dr
Ste 240
Stockbridge, GA 30281
Phone (770) 810-6922

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1310601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1639467327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 INTERSTATE NORTH PKWY SE STE 1600",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303395047",
            "telephone_number": "470-464-8000",
            "fax_number": "770-248-8192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 COUNTRY CLUB DR STE 240",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817339",
            "telephone_number": "770-810-6922",
            "fax_number": "770-810-6930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SERVICES OF AMERICA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-14",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A",
        "authorized_official_last_name": "BUCKHALTER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "470-464-8000"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "GA",
            "license": "106-R-0941",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "675782530B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aveanna Heatlhcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; 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.