BRASELTON PEDIATRICS LLC NPI 1174278808

NPI Information

  • NPI: 1174278808
  • Provider Name: BRASELTON PEDIATRICS, LLC
  • Classification: Nurse Practitioner - 363LP0200X
  • Specialization: Pediatrics
  • Entity Type: Organization
  • CLIA Number: 11D1092044
  • Address: 1897 HIGHWAY 211 NW STE 100
    HOSCHTON, GA
    ZIP 30548
  • Phone: (678) 820-7979

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NPI Details

BRASELTON PEDIATRICS, LLC is a pediatrics nurse practitioner in Hoschton, GA. BRASELTON PEDIATRICS, LLC NPI is 1174278808. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1897 HIGHWAY 211 NW STE 100
HOSCHTON, GA
ZIP 30548-513
Phone: (678) 820-7979
Fax: (678) 820-7980

The provider's authorized official is Dionne Butler .
The authorized official title is Provider/owner and has the following contact phone number (678) 455-8212.

The CLIA number assigned to this NPI record is 11D1092044 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/22/2022 and was last updated on 2/22/2022.

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
1363LP0200XNurse PractitionerPediatricsYes

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
1003113444EMEDICAIDGEORGIA

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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