NPIMap

Organization Active NPI

Abc Pediatrics

  • Pediatrics Physician
  • Fayetteville, GA
National Provider Identifier
1902923964
Registry record updated Feb 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
ABC PEDIATRICS
Practice address
735 Glynn St S
Fayetteville, GA 30214-2049
Phone
(770) 461-4126
Fax
(770) 461-8852
NPI assigned
Mar 23, 2007
Last updated
Feb 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2024

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

Authorized official

Name
Leslie Deanne Smoak, MDNPI 1619170602
Title
Physician Owner
Phone
(770) 461-4126

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

735 Glynn St S
Fayetteville, GA 30214-2049

Mailing address

735 Glynn St S
Fayetteville, GA 30214-2049
Phone (770) 461-4126

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0937556Abc Pediatrics PC735 Glynn Street, South, Fayetteville, GA 30214Certificate of waiverJul 31, 2026

National Provider Directory

National Provider Directory

Locations

735 Glynn St S
Fayetteville, GA 30214
Phone (770) 461-4126

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709078400000",
    "number": "1902923964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 GLYNN ST S",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302142049",
            "telephone_number": "770-461-4126",
            "fax_number": "770-461-8852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 GLYNN ST S",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302142049",
            "telephone_number": "770-461-4126",
            "fax_number": "770-461-8852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABC PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2024-02-28",
        "status": "A",
        "authorized_official_last_name": "SMOAK",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "DEANNE",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "770-461-4126",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; 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.