Individual provider Active NPI

Amy Kewin, MD

  • Pediatrics Physician
  • Marietta, GA
National Provider Identifier
1821088972
Registry record updated Aug 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
040118 Issued in GA
Practice address
760 Kennesaw Ave NW
Marietta, GA 30060-6909
Phone
(770) 427-0183
Fax
(770) 427-0788
NPI assigned
Oct 28, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 040118 GA Primary

Addresses

Primary practice location

760 Kennesaw Ave NW
Marietta, GA 30060-6909

Mailing address

760 Kennesaw Ave NW
Marietta, GA 30060-6909
Phone (770) 427-0183

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080521000499 GA Practitioner - Pediatric Medicine 8426127127 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Apr 1, 2011 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Apr 1, 2011 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Wellstar Kenmar Pediatrics, LLC Pediatrics Past Accepting new patients

Locations

4900 Ivey Rd NW
Ste 1326
Acworth, GA 30101
Phone (770) 427-0183

4550 Cobb Parkway North NW
Ste 302
Acworth, GA 30101
Phone (770) 427-0183

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

5150 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152
Phone (678) 354-0230

760 Kennesaw Ave NW
Marietta, GA 30060
Phone (770) 427-0183

Interoperability endpoints

  • Direct secure messaging: akewin11217@directwellstar.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408060800000",
    "number": "1821088972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 KENNESAW AVE NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300606909",
            "telephone_number": "770-427-0183",
            "fax_number": "770-427-0788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 KENNESAW AVE NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300606909",
            "telephone_number": "770-427-0183",
            "fax_number": "770-427-0788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEWIN",
        "first_name": "AMY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-28",
        "last_updated": "2014-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "040118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.