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OUR VILLAGE PEDIATRICS, LLC
NPI 1255952347
Pediatrics in Canton, GA

Active since April 30, 2020CLIA 11D2204425 · Waiver
115 ACADEMY ST, CANTON, GA 30114(470) 389-4970 Get Directions Write a Review

NPPES record last updated: April 30, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Our Village Pediatrics, Llc NPPES

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

OUR VILLAGE PEDIATRICS, LLC (NPI 1255952347) is a healthcare organization registered as a pediatrics in Canton, Georgia and active in the NPI registry since April 2020. The organization holds a CLIA Waiver certificate valid through December 8, 2026 and lists Justin Glaeser, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1255952347
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameOUR VILLAGE PEDIATRICS, LLC
Location Address115 ACADEMY STCanton, GA 30114-2860
Mailing Address115 Academy StCanton, GA 30114-2860 · (470) 389-4970
Phone(470) 389-4970
Organization SubpartNo
Authorized OfficialJustin GlaeserOffice Manager · (470) 389-4970
Enumeration DateApril 30, 2020
NPPES CertifiedApril 30, 2020
✔ NPI 1255952347 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.
115 ACADEMY ST, Canton, GA 30114
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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 Waiver 11D2204425

Our Village Pediatrics · Canton, GA
Active · expires Dec 8, 2026
CLIA Number11D2204425
Laboratory TypePhysician Office
Certificate Effective DateDecember 9, 2024
Certificate Expiration DateDecember 8, 2026
Laboratory DirectorStephanie Hassel Mcneil
Laboratory Phone(470) 389-4970
Laboratory LocationOur Village Pediatrics115 Academy Street Suite 101, Canton, GA 30114
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Our Village Pediatrics, LLC's NPI number?

The NPI number for Our Village Pediatrics, LLC is 1255952347. It was assigned to this organization in the NPPES registry on April 30, 2020.

Where is Our Village Pediatrics, LLC located?

Our Village Pediatrics, LLC is located at 115 Academy St, Canton, GA 30114. The listed phone number is (470) 389-4970.

What is Our Village Pediatrics, LLC's specialty?

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

Does Our Village Pediatrics, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2204425) is associated with this NPI, valid through December 8, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Our Village Pediatrics, LLC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Our Village Pediatrics, LLC 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 Our Village Pediatrics, LLC was last updated on April 30, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.