Active NPI
Stephen John Klacik, MD
- Pediatrics Physician
- Gainesville, GA
National Provider Identifier
1922088293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 054230
- Practice address
- 725 Jesse Jewell Pkwy SE
Gainesville, GA 30501-3834 - Phone
- (770) 535-3611
- Fax
- (770) 535-7092
- NPI assigned
- Jan 20, 2006
- Sex
- Male
- 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 | 054230 | GA | Primary |
Addresses
Primary practice location
725 Jesse Jewell Pkwy SE
Gainesville, GA 30501-3834
Mailing address
PO Box 658
Gainesville, GA 30503-0658
Phone (770) 718-1122
Other practice location 1
1270 Friendship Rd
Braselton, GA 30517-5630
Phone (678) 207-4200
Other practice location 2
155 Professional Dr
Baldwin, GA 30511-4000
Phone (706) 776-2368
Other practice location 3
4019 Executive Drive
Oakwood, GA 30566-3433
Phone (770) 533-6500
Other practice location 4
743 Spring St NE
Gainesville, GA 30501-3715
Phone (770) 535-3611
Other practice location 5
1400 River Pl
Braselton, GA 30517-5600
Phone (770) 535-3611
Other practice location 6
4095 S Lee St
Buford, GA 30518-3647
Phone (770) 932-8519
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 302580 | Other | GA | WELLCARE |
| 10032998 | Other | GA | AMERIGROUP |
| 302568 | Other | GA | WELLCARE |
| 302579 | Other | GA | WELLCARE |
| 5779768 | Other | GA | AETNA PPO |
| 845371853D | Medicaid | GA | |
| 3548885 | Other | GA | CIGNA |
| 52703273 | Other | GA | BCBS |
| 845371853B | Medicaid | GA | |
| 3532508 | Other | GA | AETNA HMO |
| 845371853A | Medicaid | GA | |
| 1908730 | Other | GA | UHC |
| 845371853C | Medicaid | GA | |
| 302581 | Other | GA | WELLCARE |
| 845371853F | Medicaid | GA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- steve.klacik@longstreetclinic.gadirect.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692230400000",
"number": "1922088293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 658",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305030658",
"telephone_number": "770-718-1122",
"fax_number": "770-535-7445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 JESSE JEWELL PKWY SE",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305013834",
"telephone_number": "770-535-3611",
"fax_number": "770-535-7092"
}
],
"practiceLocations": [
{
"address_1": "1270 Friendship Rd",
"address_purpose": "LOCATION",
"city": "Braselton",
"state": "GA",
"postal_code": "305175630",
"country_code": "US",
"telephone_number": "678-207-4200",
"fax_number": "770-533-4771",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "155 Professional Dr",
"address_purpose": "LOCATION",
"city": "Baldwin",
"state": "GA",
"postal_code": "305114000",
"country_code": "US",
"telephone_number": "706-776-2368",
"fax_number": "706-776-2589",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4019 Executive Drive",
"address_purpose": "LOCATION",
"city": "Oakwood",
"state": "GA",
"postal_code": "305663433",
"country_code": "US",
"telephone_number": "770-533-6500",
"fax_number": "770-533-6543",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "743 Spring St NE",
"address_purpose": "LOCATION",
"city": "Gainesville",
"state": "GA",
"postal_code": "305013715",
"country_code": "US",
"telephone_number": "770-535-3611",
"fax_number": "770-535-7092",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1400 River Pl",
"address_purpose": "LOCATION",
"city": "Braselton",
"state": "GA",
"postal_code": "305175600",
"country_code": "US",
"telephone_number": "770-535-3611",
"fax_number": "770-535-7092",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4095 S Lee St",
"address_purpose": "LOCATION",
"city": "Buford",
"state": "GA",
"postal_code": "305183647",
"country_code": "US",
"telephone_number": "770-932-8519",
"fax_number": "770-533-4798",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KLACIK",
"first_name": "STEPHEN",
"middle_name": "JOHN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-20",
"last_updated": "2023-08-17",
"certification_date": "2023-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "054230",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "302580",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "10032998",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "302568",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "302579",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO",
"identifier": "5779768",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "845371853D",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "3548885",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "52703273",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "845371853B",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "3532508",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "845371853A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC",
"identifier": "1908730",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "845371853C",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "302581",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "845371853F",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.