PEDIATRIC PARTNERS LLC NPI 1972591238

NPI Information

  • NPI: 1972591238
  • Provider Name: PEDIATRIC PARTNERS LLC
  • Classification: Pediatrics - 2080A0000X
  • Specialization: Adolescent Medicine
  • Entity Type: Organization
  • CLIA Number: 11D0999979
  • Address: 1520B JENNINGS MILL RD
    BOGART, GA
    ZIP 30622
  • Phone: (706) 548-1216

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NPI Details

PEDIATRIC PARTNERS LLC is an adolescent medicine pediatrics in Bogart, GA. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. PEDIATRIC PARTNERS LLC NPI is 1972591238. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1520B JENNINGS MILL RD
BOGART, GA
ZIP 30622-543
Phone: (706) 548-1216
Fax: (706) 548-1772

The provider's authorized official is Debbie L. Eubanks .
The authorized official title is Administrator and has the following contact phone number (706) 548-1216.

The CLIA number assigned to this NPI record is 11D0999979 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 10/11/2005 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
12080A0000XPediatricsAdolescent MedicineYes

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
185002970GMEDICAIDGEORGIA

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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