Kids Avenue Pediatrics LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

027036 Issued in GA

Legal business name

KIDS AVENUE PEDIATRICS LLC

Practice address

1720 Phoenix Blvd
Suite900
College Park, GA 30349-5594

Phone

(770) 909-8007

Fax

(770) 909-8005

NPI assigned

Jun 24, 2008

Last updated

Jun 24, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Phyllis Stembridge

Title

Practice Manager

Phone

(770) 909-8007

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Kids Avenue Pediatrics2 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.

• Kids Avenue Pediatrics LLC

  • Pediatrics Physician
  • College Park, GA
  • NPI 1326388752
  NPD tax ID

Locations

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.

• Gertrude Brown Arrington, MD

  • Pediatrics Physician
  • College Park, GA
  • NPI 1487697124
  NPD (past)

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1801057609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 PHOENIX BLVD",
            "address_2": "SUITE900",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303495594",
            "telephone_number": "770-909-8007",
            "fax_number": "770-909-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 PHOENIX BLVD",
            "address_2": "SUITE900",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303495594",
            "telephone_number": "770-909-8007",
            "fax_number": "770-909-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS AVENUE PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-24",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "STEMBRIDGE",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "770-909-8007"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "027036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "497361413A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenoly Emerging Technologies, LLC
• Kimberly Kerbo
• Tomeka Khaaliq, LPN
• Kidcare Pediatrics
• Kids Avenue Pediatrics LLC
• Travis E Kimble, DDS
• Malika King
• Denniesha Andrene Knight
• Kobi Care Inc.
• Matthew Kooy, PT

• Pediatrics Physician in College Park, GA
• Providers in College Park, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; 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.