PEDIATRIC DIGESTIVE HEALTH AND WELLNESS
NPI 1083394266
Pediatrics - Pediatric Gastroenterology in Loganville, GA

Active since July 21, 2023CLIA 11D2310160 · Waiver
3925 HARRISON RD STE 100, LOGANVILLE, GA 30052(706) 340-4330 Get Directions Write a Review

NPPES record last updated: September 4, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Sep 4, 2024, Jul 21, 2023 (2 updates tracked since 2023).

About Pediatric Digestive Health And Wellness NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PEDIATRIC DIGESTIVE HEALTH AND WELLNESS (NPI 1083394266) is a healthcare organization registered as a pediatric gastroenterology in Loganville, Georgia and active in the NPI registry since July 2023. The organization holds a CLIA Waiver certificate valid through August 27, 2026 and lists Derica Nicole Sams, Owner/ Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1083394266
Entity TypeOrganization
Primary Taxonomy2080P0206X
Legal Business NamePEDIATRIC DIGESTIVE HEALTH AND WELLNESS
Location Address3925 HARRISON RD STE 100Loganville, GA 30052-5898
Mailing Address3925 Harrison Rd Ste 100Loganville, GA 30052-5898 · (706) 340-4330
Organization SubpartNo
Authorized OfficialDerica Nicole SamsOwner/ Authorized Official · (706) 340-4330
Enumeration DateJuly 21, 2023
Last NPPES UpdateSeptember 4, 20242 updates tracked since enumeration
NPPES CertifiedSeptember 4, 2024
NPI 1083394266 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPediatrics · Pediatric GastroenterologyAllopathic & Osteopathic Physicians
Taxonomy Code2080P0206X
Definition

A pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs.

3925 HARRISON RD STE 100, Loganville, GA 30052

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2310160

Pediatric Digestive Health And Wellness · Loganville, GA
Active · expires Aug 27, 2026
CLIA Number11D2310160
Laboratory TypePhysician Office
Certificate Effective DateAugust 28, 2024
Certificate Expiration DateAugust 27, 2026
Laboratory DirectorDerica N. Sams
Laboratory Phone(706) 340-4330
Laboratory LocationPediatric Digestive Health And Wellness3925 Harrison Road, Suite 100, Loganville, GA 30052
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Pediatrics (Pediatric Gastroenterology)
3925 HARRISON RD STE 100
LOGANVILLE, GA 30052
Counselor (Mental Health)
3925 HARRISON RD STE 100
LOGANVILLE, GA 30052

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pediatric Digestive Health And Wellness's NPI number?

The NPI number for Pediatric Digestive Health And Wellness is 1083394266. It was assigned to this organization in the NPPES registry on July 21, 2023.

Where is Pediatric Digestive Health And Wellness located?

Pediatric Digestive Health And Wellness is located at 3925 Harrison Rd Ste 100, Loganville, GA 30052. The listed phone number is (706) 340-4330.

What is Pediatric Digestive Health And Wellness's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Gastroenterology, with taxonomy code 2080P0206X.

Does Pediatric Digestive Health And Wellness hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2310160) is associated with this NPI, valid through August 27, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Pediatric Digestive Health And Wellness was last updated on September 4, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.