Pediakare of Newnan, Inc

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

065633 Issued in GA

Legal business name

PEDIAKARE OF NEWNAN, INC

Practice address

1111 Bullsboro Dr
Suite 6 and 7
Newnan, GA 30265-2182

Phone

(706) 615-4736

Fax

(706) 221-6226

NPI assigned

Apr 7, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Shane B Darrah, M.D.

Title

Ceo

Phone

(706) 243-4500

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 4

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

• Lori Katrina Duckett, MD

  • Pediatrics Physician
  • Newnan, GA
  • NPI 1083934608
  NPD (past)
• Leauna Mitchell Merritt, CPNP-PC

  • Pediatric Nurse Practitioner
  • Newnan, GA
  • NPI 1801360094
  NPD (past)
• Jill Scott, DNP, FNP-BC, MSN, RN

  • Nurse Practitioner
  • Newnan, GA
  • NPI 1881189041
  NPD (past)
• Elizabeth Watkins, MD

  • Pediatrics Physician
  • Stockbridge, GA
  • NPI 1932373420
  NPD (past)

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

{
    "created_epoch": "1302134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302134400000",
    "number": "1982993283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9007",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319089007",
            "telephone_number": "706-615-4736",
            "fax_number": "706-221-6226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 BULLSBORO DR",
            "address_2": "SUITE 6 AND 7",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652182",
            "telephone_number": "706-615-4736",
            "fax_number": "706-221-6226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIAKARE OF NEWNAN, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-07",
        "last_updated": "2011-04-07",
        "status": "A",
        "authorized_official_last_name": "DARRAH",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-243-4500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "065633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "440194601",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peaceful Waters Hospice LLC
• Peachtree City Obstetrics and Gynecology, P.C.
• Peachtree Immediate Care FP, LLC
• Jenna Pealor
• Mashelle Annette Pearson
• Pediatric Associates of Newnan P.C.
• Pediatric Dentistry of Newnan, LLC
• Tia Chalise Penn-Tabor
• Gianna Rose Penton-Depretoro
• Harry Jacobi Peoples II, DMD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.