Vibrant Kids Pediatrics, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

061061 Issued in GA

Legal business name

VIBRANT KIDS PEDIATRICS, LLC

Practice address

10 Market Square Way Ste 100
Newnan, GA 30265-6078

Phone

(678) 423-5560

Fax

(678) 423-5563

NPI assigned

Nov 4, 2012

Organization subpart

No

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

Authorized official

Name

Jill Burnett Dickerson, MDNPI 1497714257

Title

Manager

Phone

(678) 423-5560

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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.

• Jill B Dickerson, M.D.

  • Pediatrics Physician
  • Newnan, GA
  • NPI 1497714257
  NPD (past) Authorized official
• Lauren A Jernigan, PA-C

  • Medical Physician Assistant
  • Newnan, GA
  • NPI 1003192436
  NPD (past)
• Lexis Langner Riehl, NP

  • Pediatric Nurse Practitioner
  • Newnan, GA
  • NPI 1225958671
  NPD (past)

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

{
    "created_epoch": "1351987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351987200000",
    "number": "1811241417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "87 TAPESTRY LN",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302655649",
            "telephone_number": "678-423-5560",
            "fax_number": "678-423-5563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MARKET SQUARE WAY STE 100",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302656078",
            "telephone_number": "678-423-5560",
            "fax_number": "678-423-5563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBRANT KIDS PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-04",
        "last_updated": "2012-11-04",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "BURNETT",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "678-423-5560",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "GA",
            "license": "061061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olena Vanwonterghem
• Rajendra M. Vazirani, M.D.
• Sunny L Veal, M.ED, NCC, LPC, RPT
• Francisco J Velez-Reboyras, M.D.
• Juliana M Vera Ortiz, M.D.
• John David Vickery IV, M.D.
• Victory Health System, Inc.
• Village Podiatry Group LLC
• Vital Care Transports Inc (Coweta Co EMS)
• Kent Alan Voyce, OD

• Clinic/Center in Newnan, GA
• Providers in Newnan, GA by specialty
• Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2012; 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.