NPIMap

Organization Active NPI

Kid Station Pediatrics P.C

  • Pediatrics Physician
  • Lagrange, GA
National Provider Identifier
1720213952
Registry record updated Feb 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
058657 Issued in GA
Legal business name
KID STATION PEDIATRICS P.C
Practice address
301 Medical Dr
Suite 504
Lagrange, GA 30240-4144
Phone
(706) 882-5437
NPI assigned
May 18, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2012

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

Authorized official

Name
Kalyani Angampally Rajeev, M.D
Title
Owner
Phone
(678) 481-7879

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 058657 GA Primary

Addresses

Primary practice location

301 Medical Dr
Suite 504
Lagrange, GA 30240-4144

Mailing address

301 Medical Dr
Suite 504
Lagrange, GA 30240-4144
Phone (706) 882-5437

Other identifiers 1

IdentifierTypeStateIssuer
416240451HMedicaidGA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1242604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328140800000",
    "number": "1720213952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 MEDICAL DR",
            "address_2": "SUITE 504",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404144",
            "telephone_number": "706-882-5437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MEDICAL DR",
            "address_2": "SUITE 504",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404144",
            "telephone_number": "706-882-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KID STATION PEDIATRICS P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-18",
        "last_updated": "2012-02-02",
        "status": "A",
        "authorized_official_last_name": "RAJEEV",
        "authorized_official_first_name": "KALYANI",
        "authorized_official_middle_name": "ANGAMPALLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-481-7879",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "058657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "416240451H",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lagrange, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2012; 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.