WOODSTOCK PEDIATRICS PC NPI 1104159086

NPI Information

  • NPI: 1104159086
  • Provider Name: WOODSTOCK PEDIATRICS PC
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • Doing Business As: MAIN STREET PEDIATRICS
  • CLIA Number: 11D0985933
  • Address: 460 W MAIN ST
    SUITE 100
    BLUE RIDGE, GA
    ZIP 30513
  • Phone: (706) 632-0330

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NPI Details

WOODSTOCK PEDIATRICS PC is a pediatrics in Blue Ridge, GA. The provider is 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. WOODSTOCK PEDIATRICS PC NPI is 1104159086. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Main Street Pediatrics.

The provider's business location address is:

460 W MAIN ST
SUITE 100
BLUE RIDGE, GA
ZIP 30513-127
Phone: (706) 632-0330
Fax: (706) 632-9004

The provider's authorized official is Kimberly T Williams .
The authorized official title is M.d. and has the following contact phone number (706) 632-0330.

The CLIA number assigned to this NPI record is 11D0985933 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/10/2009 and was last updated on 1/31/2011.

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
1208000000XPediatrics032063GEORGIAYes

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 Other Provider Identifier Issuer
137BBFXXMEDICARE PINGEORGIA
2H72549MEDICARE UPINGEORGIA
3000448269FMEDICAIDGEORGIA

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: 11/21/2025

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