Pediatric Clinic, PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

20280 Issued in GA

Legal business name

PEDIATRIC CLINIC, PC

Practice address

189 Medical Way
Suite C
Riverdale, GA 30274-4905

Phone

(770) 991-8900

Fax

(770) 991-8917

NPI assigned

Oct 13, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Amjad Iqbal, MDNPI 1336206531

Title

Ceo

Phone

(770) 991-8900

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amjad Iqbal, MD

  • Pediatric Adolescent Medicine Physician
  • Riverdale, GA
  • NPI 1336206531
  NPD (past) Authorized official

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

{
    "created_epoch": "1413158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413158400000",
    "number": "1902200447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 MEDICAL WAY",
            "address_2": "SUITE C",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302744905",
            "telephone_number": "770-991-8900",
            "fax_number": "770-991-8917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 MEDICAL WAY",
            "address_2": "SUITE C",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302744905",
            "telephone_number": "770-991-8900",
            "fax_number": "770-991-8917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-13",
        "last_updated": "2014-10-13",
        "status": "A",
        "authorized_official_last_name": "IQBAL",
        "authorized_official_first_name": "AMJAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-991-8900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "20280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kimbra Pearson
• Laquitta Pearson, MSW
• Michel Pekwe Leke Djomo Eko
• Felix Pelaez, M.D.
• Lindsay Patricia Peluso, FNP-C
• Victor Manuel Pena Chouiro, M.D.
• Akili Penn

• Primary Care Clinic/Center in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; 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.