THE PEDIATRIC CENTER OF STONE MOUNTAIN (NPI# 1699139675) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699139675 |
| Entity Type | Organization |
| Organization Name | THE PEDIATRIC CENTER OF STONE MOUNTAIN |
| Practice Address |
5405 Memorial Dr Ste D Stone Mountain GA 30083-3236 |
| Practice Telephone | 4042963800 |
| Mailing Telephone | 4042963800 |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2016-04-06 |
| Authorized Official Name | MS. ALICIA CHADWICK (MEDICAL HOME SPECIAL PROJECTS) |
| Authorized Official Telephone | 6787632615 |
| 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 | 300021562A | 05 |
| Street Address |
5405 MEMORIAL DR STE D |
| City | STONE MOUNTAIN |
| State | GA |
| Zip Code | 30083-3236 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518024504 | Mary Kathleen Allen | Counselor | 5405 Memorial Dr Ste D, Stone Mountain, GA 30083-3236 | 2007-01-02 |
| 1164071726 | Katherine Julia Zoppoth | Nurse Practitioner | 5405 Memorial Dr Ste D, Stone Mountain, GA 30083-3236 | 2019-09-06 |
| 1487182697 | Stacey Elizabeth Hughes | Nurse Practitioner | 5405 Memorial Dr Ste D, Stone Mountain, GA 30083-3236 | 2017-06-01 |
| 1073050449 | Justin Stewart Kitchens | Nurse Practitioner | 5405 Memorial Dr Ste D, Stone Mountain, GA 30083-3236 | 2017-01-24 |
| 1427350719 | Lucinda Johnson Sellers | Nurse Practitioner | 5405 Memorial Dr Ste D, Stone Mountain, GA 30083-3236 | 2010-11-19 |
| 1104032218 | Laura Renae Wilson | Nurse Practitioner | 5405 Memorial Dr Ste D, Stone Mountain, GA 30083-3236 | 2007-05-15 |
| 1861526030 | Laura Lynn Hudson-yedvobnick | Physician Assistant | 5405 Memorial Dr Ste D, Stone Mountain, GA 30083-3236 | 2007-03-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558830919 | Patriot Healthcare of Georgia, LLC | Family Medicine | 833 Hairston Road, Stone Mountain, GA 30083 | 2018-11-15 |
| 1710403431 | Trans Med Ems,llc | Ambulance | 4683 Redan Rd, Stone Mountain, GA 30083 | 2017-08-15 |
| 1447770482 | Dispatched Angels Home Care | In Home Supportive Care | 619 El Prado Court, Stone Mountain, GA 30083 | 2017-06-21 |
| 1396191086 | Suzanne Carter | Chore Provider | 1036 Allgood Rd, Stone Mountain, GA 30083 | 2016-05-11 |
| 1437520087 | Meaza Dada | Pharmacist | 1043 Thornwoode Lane, Stone Mountain, GA 30083 | 2015-10-08 |
| 1427436500 | Raeanne Elizabeth Gialanella | Occupational Therapist | 5839 Memorial Drive, Stone Mountain, GA 30083 | 2015-05-11 |
| 1265829824 | Latore Williams | Licensed Practical Nurse | 5300 Ridge Forest Drive, Stone Mountain, GA 30083 | 2015-04-22 |
| 1144625922 | Granville Theodore Freeman IIi | Counselor | 5000 Brittany Drive, Stone Mountain, GA 30083 | 2014-10-23 |
| 1588974208 | Terri R Collins | Counselor | 1020 Strap Hinge Trail, Stone Mountain, GA 30083 | 2010-10-15 |
| 1104064815 | Vistas Medical Center,pc | Clinic/Center | 5329 Memorial Dr Ste A, Stone Mountain, GEORGIA 30083 | 2009-02-03 |
| Find all providers in zip 30083 | ||||
| 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 |
| 1366619702 | Julia Mcmichael | Pediatrics | 1551 Juliette Dr, Stone Mountain, GA 30083-1509 | 2008-05-14 |
| 1518174036 | Northlake Pediatric Associates,pc | Pediatrics | 1805 Parke Plaza Cir, Suite 103, Stone Mountain, GA 30087-3498 | 2007-05-16 |
| 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 | 30083 |
Please comment or provide details below to improve the information on THE PEDIATRIC CENTER OF STONE MOUNTAIN.
| 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.