MRS. JADA R. OLDERMAN (NPI# 1417134545) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417134545 |
| Entity Type | Individual |
| Full Name | MRS. JADA R. OLDERMAN |
| Credential | MD |
| Practice Address |
3650 Steve Reynolds Blvd. Kaiser Permanente Gwinnett Medical Center Duluth GA 30096 |
| Mailing Address |
3495 Piedmont Road, Ne Nine Piedmont Center Atlanta GA 30305 |
| Practice Telephone | 7709316010 |
| Mailing Telephone | 4043647070 |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2012-01-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 066159 | GA | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | 002727 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
3650 STEVE REYNOLDS BLVD. KAISER PERMANENTE GWINNETT MEDICAL CENTER |
| City | DULUTH |
| State | GA |
| Zip Code | 30096 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659360568 | William Moten Craven | Orthopaedic Surgery | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2005-10-14 |
| 1851719710 | Theresa Welles | Psychologist | 3650 Steve Reynolds Blvd., Duluth, GA 30096 | 2014-03-28 |
| 1275805970 | Frances Ann Lanza | Social Worker | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2012-01-27 |
| 1750676060 | Andrea Giardina Hill | Optometrist | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2011-06-15 |
| 1588977557 | Ammar Divan | Anesthesiology | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2010-07-20 |
| 1639493224 | Nancy Huynh | Specialist | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2010-03-25 |
| 1730332131 | Lisa Bazemore Rivera | Psychiatry & Neurology | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2008-10-29 |
| 1891957528 | Ana Silvia Grosso | Pediatrics | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2008-06-25 |
| 1316107253 | Hernan Dario Urrego | Surgery | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2008-06-13 |
| 1508042268 | Carolyn Bray Hebson | Specialist | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2008-01-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922615897 | Georgia Eye Optical, LLC | Ophthalmology | 3800 Pleasant Hill Rd Ste 3, Duluth, GA 30096 | 2020-09-25 |
| 1568090868 | Positive Behavior Services, Inc | Behavior Technician | 3765 Crestwood Pkwy Nw, Duluth, GA 30096 | 2020-03-31 |
| 1861031940 | Elizabeth Ashley Edouard | Counselor | 3464 Duluth Hwy 120, Duluth, GA 30096 | 2020-01-06 |
| 1245701044 | Kathryn Irene Vaughn | Social Worker | 3968 Mainsail Court, Duluth, GA 30096 | 2018-12-06 |
| 1083184626 | Aica Orthopedics, P.C. | Orthopaedic Surgery | 3775 Venture Drive Bldg F, Duluth, GA 30096 | 2018-11-27 |
| 1245709799 | Positive Impact Health Centers, Inc. | Pharmacy | 3350 Breckinridge Blvd, Suite 200a, Duluth, GA 30096 | 2018-11-14 |
| 1235611724 | Katherine Winstead Knott | Counselor | 3460 Summit Ridge Parkway, Suite 503, Duluth, GA 30096 | 2018-08-31 |
| 1710467857 | Envision Optics LLC | Optometrist | 1943 Pleasant Hill Rd, Duluth, GA 30096 | 2018-08-17 |
| 1104314202 | Erin Mckernan Scupham | Chiropractor | 3820 Pleasant Hill Rd. Ne, Suite 4, Duluth, GA 30096 | 2018-04-25 |
| 1053839456 | Rogers Bridge Pediatric Therapy, LLC | Clinic/Center | 2845 Summercrest Ln, Duluth, GA 30096 | 2017-09-06 |
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| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538583976 | Laurie Boden | Pediatrics | 3645 Howell Ferry Road, Duluth, GA 30096 | 2014-02-05 |
| 1962763359 | Ann Adair Cody Simones | Pediatrics | 502 East Second Street, Duluth, MN 55805-1951 | 2012-06-03 |
| 1922374297 | Gc Duluth Pediatrics, Inc. | Pediatrics | 3435 Duluth Park Ln Ste A, Duluth, GA 30096-3259 | 2012-03-30 |
| 1215138524 | Cooper Pediatrics | Pediatrics | 3645 Howell Ferry Rd, Suite A, Duluth, GA 30096-3179 | 2007-05-31 |
| 1215018023 | Janet Jung | Pediatrics | 2518 Duluth Hwy, Suite 102, Duluth, GA 30097-4200 | 2006-10-18 |
| 1437167939 | Susan D Smith | Pediatrics | 3645 A Howell Ferry Rd, Duluth, GA 30096 | 2006-08-03 |
| 1457383788 | Jeffrey D Cooper | Pediatrics | 3645a Howell Ferry Road, Duluth, GA 30096 | 2006-07-07 |
| 1851321962 | Gail F Smith | Pediatrics | 3645 A Howell Ferry Road, Duluth, GA 30096 | 2006-07-04 |
| 1205886074 | Kathryn M Benson | Pediatrics | 3497 Duluth Park Lane, Ste 200, Duluth, GA 30096 | 2006-05-11 |
| 1790740249 | Teresa Marie Petros | Pediatrics | 2660 Satellite Blvd, Duluth, GA 30096-5803 | 2006-04-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.