DECATUR PEDIATRIC GROUP, PA (NPI# 1619029592) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619029592 |
| Entity Type | Organization |
| Organization Name | DECATUR PEDIATRIC GROUP, PA |
| Practice Address |
4112 E Ponce De Leon Ave Clarkston GA 30021-1817 |
| Practice Telephone | 4042967133 |
| Practice Fax Number | 4042967211 |
| Mailing Telephone | 4042967133 |
| Mailing Fax Number | 4042967211 |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. LYNETTE R WILSON-PHILLIPS (PRESIDENT) |
| Authorized Official Telephone | 4042967133 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 038132 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
4112 E PONCE DE LEON AVE |
| City | CLARKSTON |
| State | GA |
| Zip Code | 30021-1817 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366441032 | Patrice Gibson Chishom | Pediatrics | 4112 E Ponce De Leon Ave, Clarkston, GA 30021-8106 | 2005-07-15 |
| 1962038307 | Thanmayie Bethi | Nurse Practitioner | 4112 E Ponce De Leon Ave, Clarkston, GA 30021-8106 | 2020-03-17 |
| 1285278739 | Emily Schober Klingman | Registered Nurse | 4112 E Ponce De Leon Ave, Clarkston, GA 30021-8106 | 2019-10-28 |
| 1376081448 | Marlena Sherman | Nurse Practitioner | 4112 E Ponce De Leon Ave, Clarkston, GA 30021-8106 | 2017-02-08 |
| 1043690605 | Andrea Zmaj | Nurse Practitioner | 4112 E Ponce De Leon Ave, Clarkston, GA 30021-8106 | 2015-06-08 |
| 1255623575 | Liza Nicole Massey | Registered Nurse | 4112 E Ponce De Leon Ave, Clarkston, GA 30021-8106 | 2011-05-04 |
| 1548568785 | Erica Mercedes Walker | Nurse Practitioner | 4112 E Ponce De Leon Ave, Clarkston, GA 30021-8106 | 2011-03-12 |
| 1962579631 | Keanna L Joseph-clarke | Pediatrics | 4112 E Ponce De Leon Ave, Clarkston, GA 30021-8106 | 2006-11-29 |
| 1275549388 | Kimberly M Humphrey-browne | Pediatrics | 4112 E Ponce De Leon Ave, Clarkston, GA 30021-1817 | 2006-07-31 |
| 1205841046 | Shyronda Yvette Pleasant | Pediatrics | 4112 E Ponce De Leon Ave, Clarkston, GA 30021-8106 | 2006-07-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578081808 | Marqueta A Coffer | Case Manager/Care Coordinator | 1380 Brockett Pl, Clarkston, GA 30021 | 2017-09-07 |
| 1063965143 | Bertukan Worku Demas | Pharmacist | 3671 Cobble Mill Ln, Clarkston, GA 30021 | 2016-07-26 |
| 1912341967 | Esther Kim | Family Medicine | 887 N Indian Creek Dr Ste A, Clarkston, GA 30021 | 2013-04-22 |
| 1265739437 | Carepoint Home Care, LLC | In Home Supportive Care | 4122 E Ponce Deleon Avenue, Unit 9, Clarkston, GA 30021 | 2011-02-23 |
| 1790956530 | Thu D. Vu | Dentist | 3596 Hill Street, Clarkston, GA 30021 | 2008-03-20 |
| 1740310630 | Gentle Dental | Dentist | 3595 Hill St., Clarkston, GA 30021 | 2007-03-07 |
| 1679528491 | Ojoru Osunkoya | Pediatrics | 4112 E. Ponce De Leon, Clarkston, GA 30021 | 2006-05-23 |
| 1700849825 | Regina Allen Hardin | Pediatrics | 4112 E. Ponce De Leon Avenue, Clarkston, GA 30021 | 2006-04-10 |
| 1831514538 | Caudelle & Wilson Eye Care LLC | Optometrist | 320 N Jeff Davis Drive, Suite A, Fayetteville, GA 30021 | 2014-03-04 |
| 1881865624 | Vanessa Phan | Dentist | 3596 Hill Street, Clarkston, GA 30021 | 2008-03-20 |
| Find all providers in zip 30021 | ||||
| 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 |
|---|---|---|---|---|
| 1497277404 | Kids-doc-on-wheels | Pediatrics | 4112 E Ponce De Leon Ave # 2, Clarkston, GA 30021-8106 | 2017-07-11 |
| 1679528491 | Ojoru Osunkoya | Pediatrics | 4112 E. Ponce De Leon, Clarkston, GA 30021 | 2006-05-23 |
| 1669421657 | Danielle Elizabeth Leskie | Pediatrics | 5710 Bow Pointe Drive, Suite 100, Clarkston, MI 48346-3199 | 2006-05-08 |
| 1700849825 | Regina Allen Hardin | Pediatrics | 4112 E. Ponce De Leon Avenue, Clarkston, GA 30021 | 2006-04-10 |
| 1366441032 | Patrice Gibson Chishom | Pediatrics | 4112 E Ponce De Leon Ave, Clarkston, GA 30021-8106 | 2005-07-15 |
| 1417955246 | James A Oneill | Pediatrics | 5701 Bow Pointe Dr, Suite 100, Clarkston, MI 48346-3198 | 2005-07-14 |
| 1760708499 | Clarkston Urgent Care Plc | Pediatrics | 5701 Bow Pointe Dr, Suite 120, Clarkston, MI 48346-3198 | 2010-04-20 |
| 1508992041 | Michael E. Stachecki, M.d., P.l.l.c. | Pediatrics | 5885 S Main St, Suite 3, Clarkston, MI 48346-2981 | 2007-02-27 |
| 1962579631 | Keanna L Joseph-clarke | Pediatrics | 4112 E Ponce De Leon Ave, Clarkston, GA 30021-8106 | 2006-11-29 |
| 1134291982 | Premiere Pediatrics, PC | Pediatrics | 7210 N Main St, Suite 205, Clarkston, MI 48346-1575 | 2006-11-15 |
| Find all providers in CLARKSTON | ||||
Please comment or provide details below to improve the information on DECATUR PEDIATRIC GROUP, PA.
| 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.