LOCUST GROVE PEDIATRICS (NPI# 1174693519) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174693519 |
| Entity Type | Organization |
| Organization Name | LOCUST GROVE PEDIATRICS |
| Practice Address |
5040 Bill Gardner Pkwy Suite 100 Locust Grove GA 30248-3645 |
| Practice Telephone | 6785835437 |
| Practice Fax Number | 6785835484 |
| Mailing Telephone | 6785835437 |
| Mailing Fax Number | 6785835484 |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2007-09-10 |
| Authorized Official Name | JOHN MYNATT JR. (OWNER) |
| Authorized Official Telephone | 6785835437 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 041469 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
5040 BILL GARDNER PKWY SUITE 100 |
| City | LOCUST GROVE |
| State | GA |
| Zip Code | 30248-3645 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629037528 | John F Mynatt Jr. | Pediatrics | 5040 Bill Gardner Pkwy, Suite 100, Locust Grove, GA 30248-3645 | 2006-03-20 |
| 1609234129 | Tammy Green | Nurse Practitioner | 5040 Bill Gardner Pkwy, Suite 100, Locust Grove, GA 30248-3757 | 2016-01-29 |
| 1902144637 | Whitney Nicole Williams | Nurse Practitioner | 5040 Bill Gardner Pkwy, Suite 100, Locust Grove, GA 30248-3645 | 2013-01-31 |
| 1932348745 | Shanon Renee Phillips | Nurse Practitioner | 5040 Bill Gardner Pkwy, Suite 100, Locust Grove, GA 30248-3757 | 2009-02-18 |
| 1114140704 | Charmille Aimesa Garnett Hare | Family Medicine | 5040 Bill Gardner Pkwy, Suite 310, Locust Grove, GA 30248-3757 | 2007-04-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346809779 | Uyen Nguyen | Dentist | 4146 Ga-42, Locust Grove, GA 30248 | 2019-06-10 |
| 1669038303 | Monique Antoinette Joseph | Nurse Practitioner | 3334 Highway 155 Ste B, Locust Grove, GA 30248 | 2019-05-17 |
| 1811552524 | Fresenius Medical Care Locust Grove, LLC | Clinic/Center | 2855 Ga-155 S, Locust Grove, GA 30248 | 2019-05-08 |
| 1972167765 | Wesley Todd Livingston | Pharmacist | 2730 Ga 155, Locust Grove, GA 30248 | 2019-04-26 |
| 1053974550 | Wish You Well Youth Faith Foundation Inc | Contractor | 147 Laughlin Dr, Locust Grove, GA 30248 | 2019-04-19 |
| 1740776517 | Takle Eye Surgery Center LLC | Clinic/Center | 1075 Bandy Pkwy, Ste 105, Locust Grove, GA 30248 | 2018-07-05 |
| 1508357559 | Justin Robert Crumpton | Behavioral Analyst | 212 Westin Park Dr, Locust Grove, GA 30248 | 2018-05-25 |
| 1730679051 | Lisa Renee Jones | Family Medicine | 3778 G 42, Locus Grove, GA 30248 | 2018-05-11 |
| 1275042152 | Stephanie Jones Headen | Counselor | 211 Peeksville Rd., Locust Grove, GA 30248 | 2017-09-23 |
| 1942735592 | Brandi Nicole Buice Minter | Pharmacist | 4920 Bill Gardner Parkway, Locust Grove, GA 30248 | 2017-04-20 |
| Find all providers in zip 30248 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629037528 | John F Mynatt Jr. | Pediatrics | 5040 Bill Gardner Pkwy, Suite 100, Locust Grove, GA 30248-3645 | 2006-03-20 |
| 1982052130 | Rebekah Ann Steverson | Pediatrics | 3334 Highway 155, Locust Grove, GA 30248-3513 | 2016-05-27 |
| 1659650810 | Correctmed Scott, LLC | Pediatrics | 4861 Bill Gardner Pkwy, Ste 100, Locust Grove, GA 30248-3644 | 2011-08-05 |
| 1497071260 | Adam H. Johnson | Pediatrics | 4376 Germanna Hwy, Locust Grove, VA 22508-2008 | 2010-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063025690 | Sas Medical LLC | Pediatrics | 8601 Dunwoody Pl Ste 565, Sandy Springs, GA 30350-2519 | 2020-08-24 |
| 1467063248 | Kindercare Pediatrics of Georgia | Pediatrics | 174 Royal Oak Dr, Guyton, GA 31312-5624 | 2020-08-13 |
| 1649880667 | Grayson Pediatrics Mobile | Pediatrics | 297 Cooper Rd Ste B, Loganville, GA 30052-2518 | 2020-08-04 |
| 1134745953 | Molly C Shields | Pediatrics | Dugas Building Bg 107 1120 15th Street, Augusta, GA 30912-0001 | 2020-06-17 |
| 1033734918 | Lauren Wooten Smith | Pediatrics | Chog Pediatric Residency Program 1120 15th Street, Augusta, GA 30912-0001 | 2020-06-16 |
| 1225667314 | Moyosore Mary Abere | Pediatrics | 104 Bluff Chase, Bonaire, GA 31005-3867 | 2020-04-02 |
| 1447886155 | Natalie Brown Shumate | Pediatrics | 1669 Pleasant Valley Rd Ne, Monroe, GA 30655-6211 | 2020-03-14 |
| 1356988455 | Maura Mchugh Barrett | Pediatrics | 1805 Parke Plaza Cir Ste 103, Stone Mountain, GA 30087-3646 | 2019-12-08 |
| 1629614060 | Kaley Adams | Pediatrics | 227 Torrington Blvd, Thomasville, GA 31757-3904 | 2019-11-20 |
| 1164066791 | Holly Savino | Pediatrics | 603 Old Norcross Rd Ste A, Lawrenceville, GA 30046-4315 | 2019-11-06 |
| Find all providers with the same taxonomy | ||||
| City | LOCUST GROVE |
| Zip Code | 30248 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.