NORTHLAKE PEDIATRIC ASSOCIATES,PC (NPI# 1518174036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518174036 |
| Entity Type | Organization |
| Organization Name | NORTHLAKE PEDIATRIC ASSOCIATES,PC |
| Practice Address |
1805 Parke Plaza Cir Suite 103 Stone Mountain GA 30087-3498 |
| Practice Telephone | 7704989355 |
| Practice Fax Number | 7704986294 |
| Mailing Telephone | 7704989355 |
| Mailing Fax Number | 7704986294 |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2014-01-08 |
| Authorized Official Name | MRS. DELORES TALIAFERRO (OFFICE MANAGER) |
| Authorized Official Telephone | 7704989355 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 85000926G | 05 |
| Street Address |
1805 PARKE PLAZA CIR SUITE 103 |
| City | STONE MOUNTAIN |
| State | GA |
| Zip Code | 30087-3498 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104810423 | Catherine Huggins Alexander | Family Medicine | 1805 Parke Plaza Cir, Suite 101, Stone Mountain, GA 30087-3498 | 2005-08-31 |
| 1205175262 | Carla N Cooke | Physician Assistant | 1805 Parke Plaza Cir, Suite 101, Stone Mountain, GA 30087-3637 | 2013-02-11 |
| 1154624013 | Kanani Daniels Floyd | Physician Assistant | 1805 Parke Plaza Cir, Suite 101, Stone Mountain, GA 30087-3637 | 2010-12-15 |
| 1467683342 | Gyn & Ob of Dekalb, P.C. | Obstetrics & Gynecology | 1805 Parke Plaza Cir, Suite 102, Stone Mountain, GA 30087-3637 | 2009-07-27 |
| 1770790602 | Shu-tsui Lan | Physician Assistant | 1805 Parke Plaza Cir, Suite 103, Stone Mountain, GA 30087-3498 | 2007-05-17 |
| 1053485037 | Stone Mountain Family Practice, PC | Family Medicine | 1805 Parke Plaza Cir, Suite 101, Stone Mountain, GA 30087-3498 | 2006-11-20 |
| 1730110370 | Edith J Dezoort | Pediatrics | 1805 Parke Plaza Cir, Ste 103, Stone Mountain, GA 30087 | 2006-07-05 |
| 1437195492 | Raymond Rosenberg | Pediatrics | 1805 Parke Plaza Cir, Ste 103, Stone Mountain, GA 30087 | 2006-06-20 |
| 1316998255 | Stanley M Tenenbaum | Pediatrics | 1805 Parke Plaza Cir, Ste 103, Stone Mountain, GA 30087 | 2006-05-15 |
| 1255325536 | Martha H Crenshaw | Family Medicine | 1805 Parke Plaza Cir, Suite 101, Stone Mountain, GA 30087-3498 | 2005-09-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477176394 | Optimal Choice Telehealth | General Practice | 1227 Rockbidge Rd Sw, Ste 208-354, Stone Mountain, GA 30087 | 2020-05-27 |
| 1245882943 | Lynell Williams | Counselor | 505 Lilburn-stone Mountain Road, Suite 235, Stone Mountain, GA 30087 | 2019-07-12 |
| 1003302688 | Mark Andrew Stevens | Physical Therapist | 1227 Rockbridge Rd Ste 402, Stone Mountain, GA 30087 | 2018-07-06 |
| 1154816825 | Tuan Minh Khong | Physician Assistant | 6301 Southland Rdg, Stone Mountain, GA 30087 | 2018-06-26 |
| 1215429881 | Stephanie Martin | Nurse Practitioner | 2720 S Rockbridge Rd, Stone Mountain, GA 30087 | 2018-05-30 |
| 1578979381 | Edmund Thomas Jr. | Dentist | 2536 Rockbridge Rd Ste 103, Stone Mountain, GA 30087 | 2014-07-02 |
| 1790027688 | Robert Fanning Eaves Jr. | General Practice | 5394 Leatherstocking Lane, Stone Mountain, GA 30087 | 2013-03-19 |
| 1609128917 | Mary Marlene Muse | Lactation Consultant, Non-RN | 510 Navarre Drive, Stone Mountain, GA 30087 | 2012-10-10 |
| 1457680704 | Cleo Evans | Counselor | 5638 Manassas Run, Stone Mountain, GA 30087 | 2009-12-16 |
| 1932348521 | Lawrence Randy Sheber | Dentist | 5500-a Lilburn Stone Mountain Road, Stone Mountain, GA 30087 | 2009-02-05 |
| Find all providers in zip 30087 | ||||
| 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 |
|---|---|---|---|---|
| 1356988455 | Maura Mchugh Barrett | Pediatrics | 1805 Parke Plaza Cir Ste 103, Stone Mountain, GA 30087-3646 | 2019-12-08 |
| 1972600922 | Shaveanda L. Queen | Pediatrics | 5582 Memorial Dr, Stone Mountain, GA 30083-3215 | 2006-09-20 |
| 1629094719 | Winton King | Pediatrics | 4850 Redan Rd, Stone Mountain, GA 30088-2751 | 2006-07-14 |
| 1508841792 | Gregory L. Burke | Pediatrics | 1805 Parke Plaza Circle, Suite 103, Northlake Pediatric Associates, Stone Mountain, GA 30087 | 2005-12-09 |
| 1699139675 | The Pediatric Center of Stone Mountain | Pediatrics | 5405 Memorial Dr Ste D, Stone Mountain, GA 30083-3236 | 2016-04-06 |
| 1366619702 | Julia Mcmichael | Pediatrics | 1551 Juliette Dr, Stone Mountain, GA 30083-1509 | 2008-05-14 |
| 1619197498 | Edward M. Gotlieb, M.d., Et Al Dba The Pediatric Center | Pediatrics | 5405 Memorial Dr, Building D, Stone Mountain, GA 30083-3234 | 2007-04-26 |
| 1699812925 | Najeeba Bootwala | Pediatrics | 770 Village Square Dr, Stone Mountain, GA 30083-3380 | 2007-01-30 |
| 1043385131 | Tonya Grissam | Pediatrics | 925 Main St, Stone Mountain, GA 30083-3098 | 2006-11-22 |
| 1730110370 | Edith J Dezoort | Pediatrics | 1805 Parke Plaza Cir, Ste 103, Stone Mountain, GA 30087 | 2006-07-05 |
| Find all providers in STONE MOUNTAIN | ||||
| City | STONE MOUNTAIN |
| Zip Code | 30087 |
Please comment or provide details below to improve the information on NORTHLAKE PEDIATRIC ASSOCIATES,PC.
| 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.