NPIMap

Organization Active NPI

The Pediatric Center of Stone Mountain

  • Pediatrics Physician
  • Stone Mountain, GA
National Provider Identifier
1699139675
Registry record updated Apr 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
THE PEDIATRIC CENTER OF STONE MOUNTAIN
Practice address
5405 Memorial Dr Ste D
Stone Mountain, GA 30083-3236
Phone
(404) 296-3800
NPI assigned
Apr 6, 2016
Last updated
Apr 6, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2016

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

Authorized official

Name
Ms. Alicia Chadwick
Title
Medical Home Special Projects
Phone
(678) 763-2615

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

5405 Memorial Dr Ste D
Stone Mountain, GA 30083-3236

Mailing address

5405 Memorial Dr Ste D
Stone Mountain, GA 30083-3236
Phone (404) 296-3800

Other identifiers 1

IdentifierTypeStateIssuer
300021562AMedicaidGA

National Provider Directory

National Provider Directory
Tax ID family
Edward M Gotlieb MD Et Al Dba the Pediatric Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 9

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": "1459900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459900800000",
    "number": "1699139675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5405 MEMORIAL DR STE D",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833236",
            "telephone_number": "404-296-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5405 MEMORIAL DR STE D",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833236",
            "telephone_number": "404-296-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PEDIATRIC CENTER OF STONE MOUNTAIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-06",
        "last_updated": "2016-04-06",
        "status": "A",
        "authorized_official_last_name": "CHADWICK",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "MEDICAL HOME SPECIAL PROJECTS",
        "authorized_official_telephone_number": "678-763-2615",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300021562A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stone Mountain, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2016; 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.