JEFFERSON PEDIATRICS INC. NPI 1336411347

NPI Information

NPI: 1336411347
Provider Name: JEFFERSON PEDIATRICS, INC.
Classification: Clinic/Center - 261QP2300X
Specialization: Primary Care
Entity Type: Organization
CLIA Number: 11D0954160
Address: 2610 HIGHWAY 129 N
JEFFERSON, GA
ZIP 30549
Phone: (706) 367-1010

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NPI Details

JEFFERSON PEDIATRICS, INC. is a primary care clinic center in Jefferson, GA. JEFFERSON PEDIATRICS, INC. NPI is 1336411347. The provider is registered as an organization entity type.

The provider's business location address is:

2610 HIGHWAY 129 N
JEFFERSON, GA
ZIP 30549-652
Phone: (706) 367-1010

The provider's authorized official is Tammy Gail Smith .
The authorized official title is Officer and has the following contact phone number (706) 367-1010.

The CLIA number assigned to this NPI record is 11D0954160 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 2/7/2012 and was last updated on 2/7/2012.

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
1	261QP2300X	Clinic/Center	Primary Care	038372	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	Other Provider Identifier Issuer
1	10055116	OTHER	GEORGIA	AMERIGROUP
2	00608253H	MEDICAID	GEORGIA
3	309153	OTHER	GEORGIA	WELLCARE

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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