Provider Type Icon

DECATUR PEDIATRIC GROUP PA NPI 1619029592


NPI Information

NPI: 1619029592
Provider Name: DECATUR PEDIATRIC GROUP, PA
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 11D0704246

Address:
4112 E PONCE DE LEON AVE
CLARKSTON, GA
ZIP 30021
Phone: (404) 296-7133
Get Directions

DECATUR PEDIATRIC GROUP, PA is a pediatrics in Clarkston, 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. DECATUR PEDIATRIC GROUP, PA NPI is 1619029592. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4112 E PONCE DE LEON AVE
CLARKSTON, GA
ZIP 30021-817
Phone: (404) 296-7133
Fax: (404) 296-7211

The provider's authorized official is Lynette R Wilson-phillips .
The authorized official title is President and has the following contact phone number (404) 296-7133.

The CLIA number assigned to this NPI record is 11D0704246 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/18/2007 and was last updated on 8/22/2020.


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
1208000000XPediatrics038132GEORGIAYes

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.