Southern Crescent Pediatrics PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

SOUTHERN CRESCENT PEDIATRICS PC

Practice address

150 Medical Blvd
Ste B
Stockbridge, GA 30281-5053

Phone

(770) 389-9944

Fax

(770) 389-1973

NPI assigned

Aug 16, 2005

Last updated

Sep 30, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Juan Jose Sherwood, MDNPI 1417958281

Title

President

Phone

(770) 389-9944

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

Tax ID family

Southern Crescent Pediatrics PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Southern Crescent Pediatrics PC

  • Pediatrics Physician
  • Ellenwood, GA
  • NPI 1437145950
  NPD tax ID
• Southern Crescent Pediatrics PC

  • Pediatrics Physician
  • Riverdale, GA
  • NPI 1548252562
  NPD tax ID

Locations

Practitioners 3

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.

• Juan Jose Sherwood, MD

  • Pediatrics Physician
  • Stockbridge, GA
  • NPI 1417958281
  NPD (past) Authorized official
• Juan A Lama, MD

  • Pediatrics Physician
  • Stockbridge, GA
  • NPI 1033110598
  NPD (past)
• Lankala Rajendra Reddy, MD

  • Pediatrics Physician
  • Stockbridge, GA
  • NPI 1174524581
  NPD (past)

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317340800000",
    "number": "1972595999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MEDICAL BLVD",
            "address_2": "STE B",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815053",
            "telephone_number": "770-389-9944",
            "fax_number": "770-389-1973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MEDICAL BLVD",
            "address_2": "STE B",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815053",
            "telephone_number": "770-389-9944",
            "fax_number": "770-389-1973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CRESCENT PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2011-09-30",
        "status": "A",
        "authorized_official_last_name": "SHERWOOD",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "JOSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-389-9944",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "265152691",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Crescent Endoscopy Suite, PC
• Southern Crescent ENT, P.C.
• Southern Crescent Medical Center, LLC
• Southern Crescent Nephrology, PC
• Southern Crescent Pain Management LLC
• Southern Crescent Plastic Surgery ASC
• Southern Crescent Plastic Surgery, PC
• Southern Crescent Women's Health Specialists (women's health specialists)
• Southern Crescent Womens Health Specialists at Eagle's Landing (Women's Health Specialists)
• Southern Medical Clinic LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2011; 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.