PRIMARY CARE PEDIATRICS, P.C. (NPI# 1578742516) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578742516 |
| Entity Type | Organization |
| Organization Name | PRIMARY CARE PEDIATRICS, P.C. |
| Practice Address |
763 Peachtree Pkwy Ste 2 Cumming GA 30041-9351 |
| Practice Telephone | 6782082050 |
| Practice Fax Number | 6782082051 |
| Mailing Telephone | 6782082050 |
| Mailing Fax Number | 6782082051 |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2007-10-26 |
| Authorized Official Name | MR. JEROME CHARLES BOUDREAUX (CFO) |
| Authorized Official Telephone | 6782082049 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Massachusetts Corporations | PRIMARY CARE PEDIATRICS, PLLC | 1555 Commonwealth Ave., W. Newton, MA 02465 |
| Street Address |
763 PEACHTREE PKWY STE 2 |
| City | CUMMING |
| State | GA |
| Zip Code | 30041-9351 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962036905 | Annie Kyungjin Han | Nurse Practitioner | 1505 Northside Forsyth Drive, Suite 2500, Cumming, GA 30041 | 2020-02-28 |
| 1295388197 | Pamela Edler | Pharmacist | 1200 Northside Forsyth Drive, Pharmacy Department, Cumming, GA 30041 | 2019-07-19 |
| 1720557127 | Dr. Tiffany Lamonde LLC | Physical Therapist | 1445 Haw Creek Circle, Suite 503, Cumming, GA 30041 | 2018-11-15 |
| 1487140893 | Bhbd LLC | Chiropractor | 425 Peachtree Parkway, Suite 315, Cumming, GA 30041 | 2018-07-09 |
| 1891219861 | Anna Gawrys | Pharmacist | 1525 Marketplace Blvd, Cumming, GA 30041 | 2017-08-01 |
| 1679029219 | Square One Dental LLC | Clinic/Center | 3510 Rowe Lane, Cumming, GA 30041 | 2016-09-01 |
| 1720441454 | Pavilion Psychological Services LLC | Psychologist | 1445 Haw Creek Corners Circle East, Suite 501, Cumming, GA 30041 | 2016-03-31 |
| 1346606506 | American Health Imaging of Ga, LLC | Clinic/Center | 1050 Haw Creek Pkwy, Suite 100, Cumming, GA 30041 | 2016-01-04 |
| 1013311307 | Stephen Hartle | Physician Assistant | 2576 Peachtree Pkwy, Suite 100, Cumming, GA 30041 | 2014-10-15 |
| 1063828408 | Stephanie Evans Wellborn | Physician Assistant | 1800 Northside Forsyth Dr Ste 450, Cumming, GA 30041 | 2014-07-07 |
| Find all providers in zip 30041 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518459940 | Lotus Primary Care, PC | Clinic/Center | 1670 Buford Hwy, Cumming, GA 30041-6585 | 2018-06-01 |
| 1982033411 | Commonwealth Primary Care | Clinic/Center | 1614 Peachtree Pkwy, Suite # 200, Cumming, GA 30041-6883 | 2013-11-05 |
| 1407291644 | Physicians Immediate Med of Johns Creek PC | Clinic/Center | 2575 Peachtree Pkwy, Suite 100, Cumming, GA 30041-7559 | 2013-05-01 |
| 1831321280 | Firstmed of Forsyth | Clinic/Center | 907 Buford Rd, Suite 300, Cumming, GA 30041-2710 | 2009-08-19 |
| 1700914223 | Northside Family Medicine, LLC | Clinic/Center | 580 Atlanta Rd, Suite 230-a, Cumming, GA 30040-2744 | 2007-02-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942809108 | Lexington Primary Care LLC | Clinic/Center | 777 Athens Rd, Lexington, GA 30648-1902 | 2020-10-20 |
| 1619575834 | The Iv Spot, LLC. | Clinic/Center | 2100 Parklake Dr Ne # C-5, Atlanta, GA 30345-2824 | 2020-10-09 |
| 1528673514 | Safe Haven Medical Services | Clinic/Center | 444 Racetrack Rd, Mcdonough, GA 30252-6837 | 2020-09-15 |
| 1780296533 | North Atlanta Mental Wellness | Clinic/Center | 1742 Mount Vernon Rd Ste 150b, Atlanta, GA 30338-4251 | 2020-08-21 |
| 1639788136 | Walker Health and Wellness LLC | Clinic/Center | 111 Bradford Dr, Bloomingdale, GA 31302-4926 | 2020-07-30 |
| 1942827332 | Primary Care of Coastal Georgia | Clinic/Center | 214a Professional Cir, St Marys, GA 31558 | 2020-07-01 |
| 1598389637 | Mercie Health | Clinic/Center | 3721 New Macland Rd Ste 246, Powder Springs, GA 30127-2000 | 2020-06-04 |
| 1366061699 | Beyondmed LLC | Clinic/Center | 1820 Willow Branch Ln Nw, Kennesaw, GA 30152-4558 | 2020-04-16 |
| 1366082596 | Rock Health Inc | Clinic/Center | 5385 Five Forks Trickum Rd Ste F, Stone Mountain, GA 30087-3018 | 2020-01-15 |
| 1477192219 | Meridian Corporate Healthcare of Georgia P C | Clinic/Center | 5163 Thompson Bridge Rd, Murrayville, GA 30564-1930 | 2019-12-26 |
| Find all providers with the same taxonomy | ||||
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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.