NPIMap

Organization Active NPI

Cartersville Pediatric Associates

  • Pediatrics Physician
  • Cartersville, GA
National Provider Identifier
1942326491
Registry record updated Dec 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CARTERSVILLE PEDIATRIC ASSOCIATES
Practice address
958 Joe Frank Harris Pkwy SE
Suite 101
Cartersville, GA 30120-2174
Phone
(770) 386-3011
Fax
(770) 386-9451
NPI assigned
Mar 22, 2007
Last updated
Dec 2, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2016

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

Authorized official

Name
William R Payne, MDNPI 1659310357
Title
Cfo
Phone
(770) 386-3011

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 Physician 208000000X GA Primary

Addresses

Primary practice location

958 Joe Frank Harris Pkwy SE
Suite 101
Cartersville, GA 30120-2174

Mailing address

PO Box 200429
Cartersville, GA 30120-9008
Phone (770) 386-3011

Other identifiers 5

IdentifierTypeStateIssuer
003174076AMedicaidGA
00214475DMedicaidGA
00852024GMedicaidGA
00328413DMedicaidGA
0003129535AMedicaidGA

National Provider Directory

National Provider Directory

Locations

958 Joe Frank Harris Pkwy SE
#1
Cartersville, GA 30120

958 Joe Frank Harris Pkwy SE
Bldg A105
Cartersville, GA 30120

958 Joe Frank Harris Pkwy SE
Ste 101A105
Cartersville, GA 30120

958 Joe Frank Harris Pkwy SE
Ste 102A
Cartersville, GA 30120
Phone (770) 386-4824

Practitioners & affiliated clinicians

Practitioners 7

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": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480636800000",
    "number": "1942326491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 200429",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301209008",
            "telephone_number": "770-386-3011",
            "fax_number": "770-386-9451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "958 JOE FRANK HARRIS PKWY SE",
            "address_2": "SUITE 101",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301202174",
            "telephone_number": "770-386-3011",
            "fax_number": "770-386-9451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARTERSVILLE PEDIATRIC ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2016-12-02",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "770-386-3011",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003174076A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00214475D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00852024G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00328413D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0003129535A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cartersville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; 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.