DEKALB PEDIATRIC CENTER - NPI 1164695458 - Pediatrics in Decatur, GA

Q: What is Dekalb Pediatric Center's NPI number?

The NPI number for Dekalb Pediatric Center is 1164695458. It was assigned to this organization in the NPPES registry on April 8, 2008.

Q: What is Dekalb Pediatric Center's specialty?

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

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About Dekalb Pediatric Center NPPES

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

DEKALB PEDIATRIC CENTER (NPI 1164695458) is a healthcare organization registered as a pediatrics in Decatur, Georgia and active in the NPI registry since April 2008. The organization holds a CLIA Waiver certificate valid through August 6, 2026 and lists Jane Wilkov, Owner, as its authorized official.

NPPES Registry Identity

NPI1164695458

Entity TypeOrganization

Primary Taxonomy208000000X

Legal Business NameDEKALB PEDIATRIC CENTER

Location Address350 WINN WAYDecatur, GA 30030-2106

Mailing Address350 Winn WayDecatur, GA 30030-2106

Phone(404) 508-1177

Organization SubpartNo

Authorized OfficialJane WilkovOwner · (404) 508-1177

Enumeration DateApril 8, 2008

✔ NPI 1164695458 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

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.

350 WINN WAY, Decatur, GA 30030

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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 11D0918374

Dekalb Pediatric Center PC · Decatur, GA

Active · expires Aug 6, 2026

CLIA Number11D0918374

Laboratory TypePhysician Office

Certificate Effective DateAugust 7, 2024

Certificate Expiration DateAugust 6, 2026

Laboratory DirectorMelinda A. Willingham

Laboratory Phone(404) 508-1177

Laboratory LocationDekalb Pediatric Center PC350 Winn Way, Decatur, GA 30030

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 14

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

MELINDA E SHELTON MD

Pediatrics