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MAIN STREET PEDIATRICS
NPI 1104159086
Pediatrics in Blue Ridge, GA

Active since September 10, 2009CLIA 11D0985933 · Waiver
460 W MAIN ST, SUITE 100, BLUE RIDGE, GA 30513(706) 632-0330(706) 632-9004 Get Directions Write a Review

NPPES record last updated: January 31, 2011. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Main Street Pediatrics NPPES

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

MAIN STREET PEDIATRICS (NPI 1104159086) is a healthcare organization registered as a pediatrics in Blue Ridge, Georgia and active in the NPI registry since September 2009. The organization holds a CLIA Waiver certificate valid through May 1, 2027 and lists Kimberly T Williams, M.d., as its authorized official.

NPPES Registry Identity

NPI1104159086
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameWOODSTOCK PEDIATRICS PC
Location Address460 W MAIN ST, SUITE 100Blue Ridge, GA 30513-7127
Mailing Address460 W Main St, Suite 100Blue Ridge, GA 30513-7127 · (706) 632-0330 · Fax (706) 632-9004
Phone(706) 632-0330
Fax(706) 632-9004
Organization SubpartNo
Authorized OfficialKimberly T WilliamsM.d. · (706) 632-0330
Enumeration DateSeptember 10, 2009
Last NPPES UpdateJanuary 31, 2011
✔ NPI 1104159086 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in GA · 032063
Definition

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.

460 W MAIN ST, Blue Ridge, GA 30513
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Other Names 1

Doing Business AsMain Street Pediatrics

Other Identifiers 3

Medicare PIN37BBFXXGA
Medicare UPINH72549GA
Medicaid000448269FGA

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 11D0985933

Woodstock Pediatrics PC Dba Main Street Pediatrics · Blue Ridge, GA
Active · expires May 1, 2027
CLIA Number11D0985933
Laboratory TypePhysician Office
Certificate Effective DateMay 2, 2025
Certificate Expiration DateMay 1, 2027
Laboratory DirectorKimberly T. Williams
Laboratory Phone(706) 632-0330
Laboratory LocationWoodstock Pediatrics PC Dba Main Street Pediatrics460 West Main Street, Suite 100, Blue Ridge, GA 30513
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 4

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

LINDA M. SILVA, LLC
Counselor (Professional)
460 W MAIN ST, SUITE 101
BLUE RIDGE, GA 30513
Fannin County (706) 633-8145
DEBORAH H MIKOS LPC
Counselor (Professional)
460 W MAIN ST, SUITE101
BLUE RIDGE, GA 30513
Fannin County (706) 455-2490
AMANDA M NEWTON M.D.
Pediatrics
460 W MAIN ST, SUITE 100
BLUE RIDGE, GA 30513
Fannin County (706) 632-0330
KIMBERLY THOMAS WILLIAMS MD
Pediatrics
460 W MAIN ST, STE 100
BLUE RIDGE, GA 30513
Fannin County (706) 632-0330

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 Woodstock Pediatrics PC's NPI number?

The NPI number for Woodstock Pediatrics PC is 1104159086. It was assigned to this organization in the NPPES registry on September 10, 2009.

Where is Woodstock Pediatrics PC located?

Woodstock Pediatrics PC is located at 460 W Main St Suite 100, Blue Ridge, GA 30513. The listed phone number is (706) 632-0330.

What is Woodstock Pediatrics PC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Woodstock Pediatrics PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D0985933) is associated with this NPI, valid through May 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Woodstock Pediatrics PC was last updated on January 31, 2011. NPI Profile syncs with the weekly NPPES data releases published by CMS.