Pediatric Gastroenterology Associates

Primary specialty

SpecialistTaxonomy code 174400000X

License

0385519 Issued in GA

Legal business name

PEDIATRIC GASTROENTEROLOGY ASSOCIATES

Practice address

465 Winn Way
Suite 215
Decatur, GA 30030-1753

Phone

(404) 508-5315

Fax

(404) 508-5313

NPI assigned

Aug 23, 2006

Organization subpart

No

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

Authorized official

Name

Walter Ifeadike, M.D.

Title

Physician/ Owner

Phone

(404) 508-5315

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801903232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 922401",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300102401",
            "telephone_number": "404-508-5315",
            "fax_number": "404-508-5313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 WINN WAY",
            "address_2": "SUITE 215",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300301753",
            "telephone_number": "404-508-5315",
            "fax_number": "404-508-5313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC GASTROENTEROLOGY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "IFEADIKE",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "PHYSICIAN/ OWNER",
        "authorized_official_telephone_number": "404-508-5315",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "0385519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Elizabeth Peckham, RN
• Margaret Frances Pedersen, R.D., L.D.
• Jessica Lynn Pederson
• Sarah Lowe Pederson, PMHNP-BC
• Pediatric Dental Specialists of Georgia, PC
• Pediatrics and Adult Medicine Inc.
• Amanda Peeler, MCD CCC-SLP
• Janelle Summerville Peifer, PHD
• Jake Peljovich, PT, DPT
• Susan Ruth Pendleton, LCSW

• Specialist in Decatur, GA
• Providers in Decatur, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.