Camp Creek Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

049655 Issued in GA

Legal business name

CAMP CREEK PEDIATRICS

Practice address

495 Virginia Highlands
Fayetteville, GA 30215-8233

Phone

(770) 460-6459

NPI assigned

Jan 11, 2012

Organization subpart

No

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

Authorized official

Name

Kathy Ann Dyson

Title

Billing Manager

Phone

(770) 745-1070

Specialties & licenses 1

Addresses

Other names 1

• Charlene Johnson, MD Former legal business name

Tax ID family

Camp Creek 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.

• Charlene Johnson MD LLC

  • Medical Specialty Clinic/Center
  • Atlanta, GA
  • NPI 1558525071
  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.

• Charlene Johnson, M.D.

  • Pediatrics Physician
  • Atlanta, GA
  • NPI 1265498687
  NPD (past)

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

{
    "created_epoch": "1326240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326240000000",
    "number": "1891065504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2945 STONE HOGAN CONNECTOR RD SW STE 201",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303312839",
            "telephone_number": "404-349-6758",
            "fax_number": "404-349-6759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 VIRGINIA HIGHLANDS",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302158233",
            "telephone_number": "770-460-6459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMP CREEK PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-11",
        "last_updated": "2012-01-11",
        "status": "A",
        "authorized_official_last_name": "DYSON",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "770-745-1070"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "049655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charlene Johnson, MD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• McArthur Cadet, MD
• Caedel Wellness Center
• Teresa Cagle
• Michele Lyn Caldwell, NP
• Christopher Calvin
• Doris Johanna Campanelli, CNM
• Canara Cares LLC
• Anne Rankin Cannon, AUD.
• Cardiac Disease Specialists, PC
• Cardiac Disease Specialists, PC

• Pediatrics Physician in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; 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.