GC Duluth Pediatrics, Inc.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

049206 Issued in GA

Legal business name

GC DULUTH PEDIATRICS, INC.

Practice address

3435 Duluth Park LN Ste a
Duluth, GA 30096-3259

Phone

(678) 417-0407

NPI assigned

Mar 30, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Samuel SongNPI 1598762627

Title

President

Phone

(678) 417-0407

Specialties & licenses 1

Addresses

Other identifiers 1

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

CLIA laboratory certificates

Locations

Practitioners 2

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

• Samuel H Song, M.D.

  • Pediatrics Physician
  • Duluth, GA
  • NPI 1598762627
  NPD (past) Authorized official
• Yejin Kim, M.D.

  • Pediatrics Physician
  • Duluth, GA
  • NPI 1114089596
  NPD (past)

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

{
    "created_epoch": "1333065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333065600000",
    "number": "1922374297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3435 DULUTH PARK LN STE A",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300963259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3435 DULUTH PARK LN STE A",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300963259",
            "telephone_number": "678-417-0407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GC DULUTH PEDIATRICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-30",
        "last_updated": "2012-03-30",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-417-0407",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "049206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "442074795A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gary S Martin PC
• Leslie S Gaskill, M.D.
• Tametria Shyerell Gason
• Gathering Precious Stones LLC
• Adeola Adefowoju Gbenro, LPC
• GDC Endoscopy Center LLC
• Lora M Gennardo
• Genova Diagnostics Inc
• Thomas E Geoghegan, DDS
• Vanessa George-King

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2012; 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.