PRIME PEDIATRICS PC NPI 1053578450

NPI Information

NPI: 1053578450
Provider Name: PRIME PEDIATRICS PC
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

CLIA Number: 11D0976863

Address:
1610 BROADRICK DR
DALTON, GA
ZIP 30720
Phone: (706) 279-1994
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PRIME PEDIATRICS PC is an adolescent medicine pediatrics in Dalton, GA. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. PRIME PEDIATRICS PC NPI is 1053578450. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1610 BROADRICK DR
DALTON, GA
ZIP 30720-012
Phone: (706) 279-1994
Fax: (706) 279-9229

The provider's authorized official is Debbie W Chadwick .
The authorized official title is Office Manager and has the following contact phone number (706) 279-1994.

The CLIA number assigned to this NPI record is 11D0976863 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 5/22/2008 and was last updated on 5/22/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080A0000X	Pediatrics	Adolescent Medicine	37896	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	964266319A	MEDICAID	GEORGIA
2	000910214A	MEDICAID	GEORGIA
3	803486775A	MEDICAID	GEORGIA
4	000572525C	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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