PEDIATRIC GASTROENTEROLOGY ASSOCIATES (NPI# 1801903232) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801903232 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC GASTROENTEROLOGY ASSOCIATES |
| Practice Address |
465 Winn Way Suite 215 Decatur GA 30030-1753 |
| Mailing Address |
Po Box 922401 Norcross GA 30010-2401 |
| Practice Telephone | 4045085315 |
| Practice Fax Number | 4045085313 |
| Mailing Telephone | 4045085315 |
| Mailing Fax Number | 4045085313 |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | WALTER IFEADIKE (PHYSICIAN/ OWNER) |
| Authorized Official Telephone | 4045085315 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 0385519 | GA | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750609129 | Pediatric Gastroenterology Associates | Pediatrics | 11 Sprint Dr Ste B, Carlisle, PA 17015-7789 | 2010-05-11 |
| Street Address |
465 WINN WAY SUITE 215 |
| City | DECATUR |
| State | GA |
| Zip Code | 30030-1753 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093707325 | Gayle Leff Goldstein | Ophthalmology | 465 Winn Way, Ste 140, Decatur, GA 30030-1753 | 2005-08-23 |
| 1184230237 | Miracle Penny | Behavior Technician | 465 Winn Way, Decatur, GA 30030-1753 | 2020-09-23 |
| 1447874862 | Nicholas Okeith Rocker | Behavior Technician | 465 Winn Way, Decatur, GA 30030-1753 | 2020-06-01 |
| 1811349640 | Advanced Counseling Services | Counselor | 465 Winn Way, Suite 150, Decatur, GA 30030-1753 | 2016-07-05 |
| 1003296062 | Shaina Gordon | Counselor | 465 Winn Way, 221, Decatur, GA 30030-1753 | 2015-06-04 |
| 1386929073 | Robin May | Counselor | 465 Winn Way, Suite 221, Decatur, GA 30030-1753 | 2011-10-13 |
| 1013200070 | Anna Christina Davis | Counselor | 465 Winn Way, Suite 221, Decatur, GA 30030-1753 | 2011-05-24 |
| 1497052963 | South Central Community and Social Services LLC | Community/Behavioral Health | 465 Winn Way, Suite 150, Decatur, GA 30030-1753 | 2011-02-18 |
| 1164751012 | Michael B Stubbs Md PC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 465 Winn Way, Suite 211, Decatur, GA 30030-1753 | 2009-12-23 |
| 1083858716 | Susan Laney Castle | Nurse Practitioner | 465 Winn Way, Suite 215, Decatur, GA 30030-1753 | 2009-04-24 |
| Find all providers in the same location | ||||
| 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 | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225658511 | Louis P Towles IIi | Specialist | 755 Commerce Dr Ste 600, Decatur, GA 30030-2619 | 2020-04-16 |
| 1679007835 | Sara Gibson | Specialist | 3260 Wakefield Dr, Decatur, GA 30034-4554 | 2017-04-14 |
| 1033660345 | Sabra Services LLC | Specialist | 726 County Road 3250, Decatur, TX 76234-4857 | 2016-10-21 |
| 1154874758 | Erica Nicole West | Specialist | 3446 Newberry Trl, Decatur, GA 30034-3248 | 2016-07-31 |
| 1639552649 | Supreme Healthcare Ob/gyn LLC | Specialist | 5536 Flat Shoals Pkwy, Suite A, Decatur, GA 30034-5408 | 2015-07-08 |
| 1427474766 | Russell Clinding | Specialist | 5036 Snapfinger Woods Dr Ste 217, Decatur, GA 30035-4047 | 2014-03-11 |
| 1598013831 | Total Health Pain Center | Specialist | 4150 Snapfinger Way, Suite 102, Decatur, GA 30035-2711 | 2012-08-16 |
| 1841420510 | Deborah Tawil | Specialist | 118 Barry St, Decatur, GA 30030-3465 | 2009-07-16 |
| 1396973665 | Wanda Denise Nelson | Specialist | 3275 Creekway Ln, Decatur, GA 30034-4909 | 2009-06-25 |
| 1053588731 | David Douglas Shepard | Specialist | 2675 N Decatur Rd Ste 200, Decatur, GA 30033-6132 | 2008-05-13 |
| Find all providers in DECATUR | ||||
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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.