NPIMap

Organization Active NPI

Pediatric Partners LLC

  • Pediatric Adolescent Medicine Physician
  • Bogart, GA
National Provider Identifier
1972591238
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
PEDIATRIC PARTNERS LLC
Practice address
1520B Jennings Mill Rd
Bogart, GA 30622-2543
Phone
(706) 548-1216
Fax
(706) 548-1772
NPI assigned
Oct 11, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Debbie L. Eubanks
Title
Administrator
Phone
(706) 548-1216

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X Primary

Addresses

Primary practice location

1520B Jennings Mill Rd
Bogart, GA 30622-2543

Mailing address

1520B Jennings Mill Rd
Bogart, GA 30622-2543
Phone (706) 548-1216

Other identifiers 1

IdentifierTypeStateIssuer
85002970GMedicaidGA

National Provider Directory

National Provider Directory

Locations

1091 Park Dr
Watkinsville, GA 30677

1500 Langford Dr
Bldg 100
Watkinsville, GA 30677
Phone (706) 548-1216

Practitioners & affiliated clinicians

Practitioners 6

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": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972591238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520B JENNINGS MILL RD",
            "city": "BOGART",
            "state": "GA",
            "postal_code": "306222543",
            "telephone_number": "706-548-1216",
            "fax_number": "706-548-1772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520B JENNINGS MILL RD",
            "city": "BOGART",
            "state": "GA",
            "postal_code": "306222543",
            "telephone_number": "706-548-1216",
            "fax_number": "706-548-1772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PARTNERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EUBANKS",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "706-548-1216"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "85002970G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bogart, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.