Active NPI
Elaine C Youngblood, MD
- Pediatrics Physician
- Stockbridge, GA
National Provider Identifier
1831132646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 043513
- Practice address
- 1045 Southcrest Dr
Ste 110
Stockbridge, GA 30281 - Phone
- (770) 507-2212
- Fax
- (770) 507-2213
- NPI assigned
- Jun 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 043513 | GA | Primary |
Addresses
Primary practice location
1045 Southcrest Dr
Ste 110
Stockbridge, GA 30281
Mailing address
1045 Southcrest Dr
Ste 110
Stockbridge, GA 30281
Phone (770) 507-2212
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000756599C | Medicaid | GA | |
| 52671130 | Other | GA | BCBS |
Other names 1
- Elaine Camille Stone
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 043513 | GA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kids First Pediatric Group, LLC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pediatrics Physician
- Stockbridge, GA
- NPI 1720117989
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359504000000",
"number": "1831132646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1045 SOUTHCREST DR",
"address_2": "STE 110",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "30281",
"telephone_number": "770-507-2212",
"fax_number": "770-507-2213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1045 SOUTHCREST DR",
"address_2": "STE 110",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "30281",
"telephone_number": "770-507-2212",
"fax_number": "770-507-2213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNGBLOOD",
"first_name": "ELAINE",
"middle_name": "C",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-13",
"last_updated": "2013-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "043513",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000756599C",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "52671130",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ELAINE",
"last_name": "STONE",
"middle_name": "CAMILLE",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Stockbridge, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.