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LOCUST GROVE PEDIATRICS
NPI 1174693519
Pediatrics in Locust Grove, GA

Active since November 09, 2006CLIA 11D1031340 · Accreditation
5040 BILL GARDNER PKWY, SUITE 100, LOCUST GROVE, GA 30248(678) 583-5437(678) 583-5484 Get Directions Write a Review

NPPES record last updated: September 10, 2007. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Locust Grove Pediatrics NPPES

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

LOCUST GROVE PEDIATRICS (NPI 1174693519) is a healthcare organization registered as a pediatrics in Locust Grove, Georgia and active in the NPI registry since November 2006. The organization holds an CLIA Accreditation certificate valid through February 12, 2027 and lists John Mynatt, Owner, as its authorized official.

NPPES Registry Identity

NPI1174693519
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameLOCUST GROVE PEDIATRICS
Location Address5040 BILL GARDNER PKWY, SUITE 100Locust Grove, GA 30248-3645
Mailing Address5040 Bill Gardner Pkwy, Suite 100Locust Grove, GA 30248-3645 · (678) 583-5437 · Fax (678) 583-5484
Phone(678) 583-5437
Fax(678) 583-5484
Organization SubpartNo
Authorized OfficialJohn MynattOwner · (678) 583-5437
Enumeration DateNovember 9, 2006
Last NPPES UpdateSeptember 10, 2007
✔ NPI 1174693519 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in GA · 041469
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.
5040 BILL GARDNER PKWY, Locust Grove, GA 30248
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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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

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 Accreditation 11D1031340

Locust Grove Pediatrics LLC · Locust Grove, GA
Active · expires Feb 12, 2027
CLIA Number11D1031340
Laboratory TypePhysician Office
Certificate Effective DateFebruary 13, 2025
Certificate Expiration DateFebruary 12, 2027
Laboratory DirectorDr. John F. Mynatt Jr
Laboratory Phone(678) 583-5437
Laboratory LocationLocust Grove Pediatrics LLC5040 Bill Gardner Parkway, Suite 100, Locust Grove, GA 30248
CLIA data matches this NPI record on: Address Name Phone
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Other Providers at the Same Location NPPES 3

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

CHARMILLE AIMESA GARNETT HARE DO
Family Medicine
5040 BILL GARDNER PKWY, SUITE 310
LOCUST GROVE, GA 30248
Henry County (770) 898-4339
TAMMY GREEN CPNP
Nurse Practitioner
5040 BILL GARDNER PKWY, SUITE 100
LOCUST GROVE, GA 30248
Henry County (678) 583-5437
JOHN F MYNATT JR. MD
Pediatrics
5040 BILL GARDNER PKWY, SUITE 100
LOCUST GROVE, GA 30248
Henry County (678) 583-5437

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 Locust Grove Pediatrics's NPI number?

The NPI number for Locust Grove Pediatrics is 1174693519. It was assigned to this organization in the NPPES registry on November 9, 2006.

Where is Locust Grove Pediatrics located?

Locust Grove Pediatrics is located at 5040 Bill Gardner Pkwy Suite 100, Locust Grove, GA 30248. The listed phone number is (678) 583-5437.

What is Locust Grove Pediatrics's specialty?

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

Does Locust Grove Pediatrics hold a CLIA laboratory certificate?

Yes. A Certificate of Accreditation (number 11D1031340) is associated with this NPI, valid through February 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Locust Grove Pediatrics accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Locust Grove Pediatrics as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Locust Grove Pediatrics was last updated on September 10, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.