NPIMap

Organization Active NPI

Center for Pediatric Wellness, P.C.

  • Pediatrics Physician
  • Atlanta, GA
National Provider Identifier
1922392190
Registry record updated Jun 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
034754 Issued in GA
Legal business name
CENTER FOR PEDIATRIC WELLNESS, P.C.
Practice address
960 Johnson Ferry Rd NE
Suite 315
Atlanta, GA 30342-1631
Phone
(404) 389-1600
Fax
(404) 389-1610
NPI assigned
Jun 6, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2011

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

Authorized official

Name
Dr. Elizabeth M. Leduc, M.D.NPI 1700841509
Title
President
Phone
(404) 389-1600

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 034754 GA Primary

Addresses

Primary practice location

960 Johnson Ferry Rd NE
Suite 315
Atlanta, GA 30342-1631

Mailing address

960 Johnson Ferry Rd NE
Suite 315
Atlanta, GA 30342-1631
Phone (404) 389-1600

Other identifiers 1

IdentifierTypeStateIssuer
000553781BMedicaidGA

National Provider Directory

National Provider Directory

Locations

960 Johnson Ferry Rd
Ste 315
Sandy Springs, GA 30342
Phone (404) 389-1600

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1307318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307318400000",
    "number": "1922392190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 JOHNSON FERRY RD NE",
            "address_2": "SUITE 315",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421631",
            "telephone_number": "404-389-1600",
            "fax_number": "404-389-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 JOHNSON FERRY RD NE",
            "address_2": "SUITE 315",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421631",
            "telephone_number": "404-389-1600",
            "fax_number": "404-389-1610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR PEDIATRIC WELLNESS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-06",
        "last_updated": "2011-06-06",
        "status": "A",
        "authorized_official_last_name": "LEDUC",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-389-1600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "034754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000553781B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2011; 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.