DR. W. JEFFERSON PENDERGRAST M.D. NPI 1376603894

NPI Information

  • NPI: 1376603894
  • Provider Name: DR. W. JEFFERSON PENDERGRAST, M.D.
  • Classification: Specialist - 174400000X
  • Entity Type: Individual
  • Address: 2505 FLAIR KNOLL CT NE
    ATLANTA, GA
    ZIP 30345
  • Phone: (404) 636-2332

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NPI Details

DR. W. Jefferson Pendergrast, M.D. is a specialist in Atlanta, GA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. DR. W. Jefferson Pendergrast, M.D. NPI is 1376603894. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2505 FLAIR KNOLL CT NE
ATLANTA, GA
ZIP 30345-311
Phone: (404) 636-2332

The enumeration date for this NPI number is 12/12/2006 and was last updated on 4/14/2011.

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
1174400000XSpecialist015409GEORGIAYes

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

NPI Synchronization or Removal

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