MAMA DOC PEDIATRICS, LLC (NPI# 1477009181) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477009181 |
| Entity Type | Organization |
| Organization Name | MAMA DOC PEDIATRICS, LLC |
| Practice Address |
400 East Grady Street Statesboro GA 30458 |
| Practice Telephone | 9128715437 |
| Practice Fax Number | 9126232037 |
| Mailing Telephone | 9128715437 |
| Mailing Fax Number | 9126232037 |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |
| Authorized Official Name | DR. ELIZABETH LOGAN PENN (PHYSICIAN / PRESIDENT) |
| Authorized Official Telephone | 9128715437 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 67374 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
400 EAST GRADY STREET |
| City | STATESBORO |
| State | GA |
| Zip Code | 30458 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639642218 | Youtherapy | Counselor | 430 Northside Dr East, Suite 160 Mb326, Statesboro, GA 30458 | 2019-01-07 |
| 1053891853 | Alexandria Franklin | Specialist/Technologist | 1332 Southern Dr, Statesboro, GA 30458 | 2018-08-21 |
| 1740780006 | Michael Ryan Clark | Pharmacist | 556 Northside Drive, Statesboro, GA 30458 | 2018-02-13 |
| 1689186405 | Chandler James Herman | Specialist/Technologist | 590 Herty Dr., Statesboro, GA 30458 | 2017-11-02 |
| 1053761171 | Rebekah Roessler | Specialist/Technologist | 2687 Akins Blvd, Statesboro, GA 30458 | 2016-06-20 |
| 1427412253 | Refocus Counseling and Consulting Services | Community/Behavioral Health | 4325 Country Club, 4, Statesboro, GA 30458 | 2016-04-07 |
| 1023408523 | Kacy H. Nesmith | Nurse Practitioner | 1098 Bermuda Run, Suite 6, Statesboro, GA 30458 | 2015-02-04 |
| 1760870398 | Jessica Pasternack | Specialist/Technologist | 2687 Akins Boulevard, Statesboro, GA 30458 | 2015-01-06 |
| 1922401629 | Nathan D'amico | Student in an Organized Health Care Education/Training Program | 15 W Grady Street Unit A, Statesboro, GA 30458 | 2014-10-08 |
| 1487054409 | Samantha Transou | Specialist/Technologist | 207 Herschel Dr., Statesboro, GA 30458 | 2014-08-27 |
| Find all providers in zip 30458 | ||||
| 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 |
|---|---|---|---|---|
| 1538420534 | Anna Benson | Pediatrics | 4451 Country Club Rd Ste B, Statesboro, GA 30458-9255 | 2012-06-06 |
| 1245465913 | Sudhakara M Reddy | Pediatrics | 404 Savannah Ave, Statesboro, GA 30458-5102 | 2009-05-23 |
| 1669538815 | Michael C Deal | Pediatrics | 112 Hill Pond Ln, Statesboro, GA 30458-0872 | 2006-12-29 |
| 1457441644 | Cindy O'bryant Gartmond | Pediatrics | 1570 Brampton Ave, Statesboro, GA 30458-0855 | 2006-10-16 |
| 1447340773 | Frances Elizabeth Logan Penn | Pediatrics | 16741 Ga Highway 67, Suite F, Statesboro, GA 30458-2528 | 2006-10-16 |
| 1205924289 | Olufowobi Gbadebo | Pediatrics | 116 Hill Pond Ln, Statesboro, GA 30458-0872 | 2006-10-11 |
| 1720196520 | Rao Prasad Immaneni | Pediatrics | 1230 Brampton Ave, Statesboro, GA 30458-0849 | 2006-08-29 |
| 1013931617 | Michelle R Zeanah | Pediatrics | 406 Savannah Ave, Statesboro, GA 30458-5102 | 2006-07-27 |
| 1699744623 | Cheryl E Perkins | Pediatrics | 1044 Bermuda Run, Statesboro, GA 30458-0858 | 2006-03-14 |
| 1427303015 | Elizabeth L Penn Md PC | Pediatrics | 16741 Ga Highway 67, Ste F, Statesboro, GA 30458-2528 | 2012-07-19 |
| Find all providers in STATESBORO | ||||
| City | STATESBORO |
| Zip Code | 30458 |
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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.