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PERFORMANCE PEDIATRICS AND SPORTS MEDICINE LLC NPI 1295081321


NPI Information

NPI: 1295081321
Provider Name: PERFORMANCE PEDIATRICS AND SPORTS MEDICINE, LLC
Classification: Pediatrics - 2080S0010X
Entity Type: Organization

Specialization: Sports Medicine

Address:
1181 LANGFORD DR
BLDG 200-101
BOGART, GA
ZIP 30622
Phone: (706) 207-6694
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PERFORMANCE PEDIATRICS AND SPORTS MEDICINE, LLC is a sports medicine pediatrics in Bogart, GA. The provider is a pediatrician who is responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the healthcare of the individual engaged in physical exercise (sports) whether as an individual or in team participation. PERFORMANCE PEDIATRICS AND SPORTS MEDICINE, LLC NPI is 1295081321. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1181 LANGFORD DR
BLDG 200-101
BOGART, GA
ZIP 30622-542
Phone: (706) 207-6694

The provider's authorized official is Tara Ann Merritt .
The authorized official title is Owner Physician and has the following contact phone number (706) 202-3236.

The enumeration date for this NPI number is 7/26/2012 and was last updated on 7/26/2012.


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
1207R00000XInternal Medicine58543GEORGIANo
2208000000XPediatrics58543GEORGIANo
32080S0010XPediatricsSports Medicine58543GEORGIAYes

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
158543OTHERGEORGIASTATE MEDICAL LICENSE
2489449582CMEDICAIDGEORGIA
3003125239AMEDICAIDGEORGIA

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: 5/5/2024

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