THE EMORY CLINIC PEDIATRIC PROVIDERS (NPI# 1720285653) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720285653 |
| Entity Type | Organization |
| Organization Name | THE EMORY CLINIC PEDIATRIC PROVIDERS |
| Practice Address |
101 W Ponce De Leon Ave Ste 300 Decatur GA 30030-2528 |
| Mailing Address |
1365 Clifton Rd Ne Atlanta GA 30322-1013 |
| Practice Telephone | 4047782144 |
| Practice Fax Number | 4047787466 |
| Mailing Telephone | 4047782144 |
| Mailing Fax Number | 4047784819 |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DOROTHY COOK WALTER (DIRECTOR SYSTEM CREDENTIALING) |
| Authorized Official Telephone | 4047782144 |
| Authorized Official Credential | RN, MN, JD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 207LP3000X |
Anesthesiology Specialization: Pediatric Anesthesiology |
Allopathic & Osteopathic Physicians | ||
| X | 207NP0225X |
Dermatology Specialization: Pediatric Dermatology |
Allopathic & Osteopathic Physicians | ||
| X | 207XP3100X |
Orthopaedic Surgery Specialization: Pediatric Orthopaedic Surgery |
Allopathic & Osteopathic Physicians | ||
| X | 207YP0228X |
Otolaryngology Specialization: Pediatric Otolaryngology |
Allopathic & Osteopathic Physicians | ||
| X | 207ZP0213X |
Pathology Specialization: Pediatric Pathology |
Allopathic & Osteopathic Physicians | ||
| X | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
Allopathic & Osteopathic Physicians | ||
| X | 2085P0229X |
Radiology Specialization: Pediatric Radiology |
Allopathic & Osteopathic Physicians | ||
| X | 2086S0120X |
Surgery Specialization: Pediatric Surgery |
Allopathic & Osteopathic Physicians |
| Street Address |
101 W PONCE DE LEON AVE STE 300 |
| City | DECATUR |
| State | GA |
| Zip Code | 30030-2528 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366516304 | James Mitchell Hughes | Internal Medicine | 101 W Ponce De Leon Ave, Suite 300, Decatur, GA 30030-2528 | 2006-11-20 |
| 1811329204 | Sharon Christina Benton | Nurse Practitioner | 101 W Ponce De Leon Ave, #242, Decatur, GA 30030-2542 | 2013-08-07 |
| 1013251859 | Tammy Vardeman Aguilar | Nurse Practitioner | 101 W Ponce De Leon Ave, Suite #242, Decatur, GA 30030-2542 | 2012-11-17 |
| 1740547033 | The Emory Clinic | Preferred Provider Organization | 101 W Ponce De Leon Ave, Decatur, GA 30030-2542 | 2012-04-12 |
| 1306112511 | Erika Phindile Chowa | Emergency Medicine | 101 W Ponce De Leon Ave, Annex Building, Decatur, GA 30030-2542 | 2012-04-02 |
| 1629345798 | Kathryn Lisa Bennett | Nurse Practitioner | 101 W Ponce De Leon Ave, #242, Decatur, GA 30030-2542 | 2011-11-17 |
| 1831492438 | Hallie Turkish Brinn | Nurse Practitioner | 101 W Ponce De Leon Ave, Decatur, GA 30030-2542 | 2010-12-21 |
| 1851606487 | Jessica Ross | Nurse Practitioner | 101 W Ponce De Leon Ave, Suite 242, Decatur, GA 30030-2542 | 2010-08-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801413174 | Pa-c Surgical Assist, LLC | Clinic/Center | 520 W Ponce Leon Ave #1706, Decatur, GA 30030 | 2020-07-02 |
| 1417587478 | Elizabeth Heffron | Acupuncturist | 619b East College Avenue, Decatur, GA 30030 | 2020-01-17 |
| 1669016143 | Atlanta Upper Cervical Chiropractic LLC | Chiropractor | 125 E Trinity Place, Suite #247, Decatur, GA 30030 | 2019-10-29 |
| 1831757418 | Jessica Stewart | Counselor | 755 Commerce Dr Ste 903, Decatur, GA 30030 | 2019-05-30 |
| 1699238733 | Dinah Augustin | Registered Nurse | 1458 Church St., Unit B, Decatur, GA 30030 | 2019-04-06 |
| 1093284291 | Eliza Segell | Social Worker | 165 Dekalb Industrial Way Ste D-1, Decatur, GA 30030 | 2018-11-16 |
| 1912476466 | Positive Impact Health Centers, Inc. | Pharmacy | 523 Church Street, Suite B, Decatur, GA 30030 | 2018-11-14 |
| 1932685096 | T2 Imaging | Radiology | 1376 Church Street, Suite 100, Decatur, GA 30030 | 2018-07-12 |
| 1992292858 | Keeanna M Powell | Counselor | Agape Transformation Practice, 235 E. Ponce De Leon Ave Suite 103, Decatur, GA 30030 | 2018-04-17 |
| 1780185488 | Solutions Ae Inc | Counselor | One West Square Court, Suite 710, Decatur, GA 30030 | 2018-02-27 |
| Find all providers in zip 30030 | ||||
| Taxonomy Code | 207LP3000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Pediatric Anesthesiology |
| An anesthesiologist who has had additional skill and experience in and is primarily concerned with the anesthesia, sedation, and pain management needs of infants and children. A pediatric anesthesiologist generally provides services including the evaluation of complex medical problems in infants and children when surgery is necessary, planning and care for children before and after surgery, pain control, anesthesia and sedation for any procedures out of the operating room such as MRI, CT scan, and radiation therapy. |
| Notes: Source: American Academy of Pediatrics, www.aap.org [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265047450 | Osama Hamed Ibrahim Elazzouny | Anesthesiology | 1311 Bon Air Dr, Augusta, GA 30907-3238 | 2020-09-14 |
| 1114525003 | Emily Kowal | Anesthesiology | 1001 Johnson Fy Rd Ne, Atlanta, GA 30342-1605 | 2020-10-13 |
| 1245869551 | Kelsey Rae Bohm | Anesthesiology | 1405 Clifton Rd Ne, Atlanta, GA 30322-1060 | 2020-04-07 |
| 1972905396 | Wellstar Medical Group, LLC | Anesthesiology | 1180 Ernest W Barrett Pkwy Nw, Suite 100, Kennesaw, GA 30144-4534 | 2014-09-17 |
| 1225458342 | Michael Craig Fiedorek | Anesthesiology | 1405 Clifton Rd Ne, Atlanta, GA 30322-1060 | 2014-04-17 |
| 1750727814 | Amit Bhakta | Anesthesiology | 1001 Johnson Fy Rd Ne, Atlanta, GA 30342 | 2013-05-16 |
| 1912297938 | Laura Elizabeth Gilbertson | Anesthesiology | 1405 Clifton Rd Ne, Children's Healthcare of Atlanta, Atlanta, GA 30322-1060 | 2011-04-11 |
| 1174758742 | Andrea Dillard | Anesthesiology | 6335 Hospital Pkwy Ste 111, Johns Creek, GA 30097-1550 | 2009-05-26 |
| 1770718843 | Justin B Long | Anesthesiology | 1405 Clifton Rd Ne, Atlanta, GA 30322-1060 | 2009-05-19 |
| 1912181819 | Vidya S Yalamanchili | Anesthesiology | 1405 Clifton Rd Ne, Atlanta, GA 30322-1060 | 2007-12-27 |
| Find all providers with the same taxonomy | ||||
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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.