1. Home
  2. Directory
  3. Georgia
  4. Cumming
  5. Pediatrics
  6. NPI Profile

LAKESIDE PEDIATRICS, LLC
NPI 1326317520
Pediatrics in Cumming, GA

Active since December 19, 2011CLIA 11D0912305 · Waiver
204 CANTON RD, CUMMING, GA 30040(770) 886-5437(770) 886-9717 Get Directions Write a Review

NPPES record last updated: December 19, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Lakeside Pediatrics, Llc NPPES

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

LAKESIDE PEDIATRICS, LLC (NPI 1326317520) is a healthcare organization registered as a pediatrics in Cumming, Georgia and active in the NPI registry since December 2011. The organization holds a CLIA Waiver certificate valid through February 28, 2028 and lists Bob B Bagheri, President, as its authorized official.

NPPES Registry Identity

NPI1326317520
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameLAKESIDE PEDIATRICS, LLC
Location Address204 CANTON RDCumming, GA 30040-2304
Mailing Address11565 Mountain Laurel DrRoswell, GA 30075-1333 · (770) 886-5437 · Fax (770) 886-9717
Phone(770) 886-5437
Fax(770) 886-9717
Organization SubpartNo
Authorized OfficialBob B BagheriPresident · (770) 886-5437
Enumeration DateDecember 19, 2011
✔ NPI 1326317520 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Licenses✔ Licensed in GA · 040865✔ Licensed in GA · 050209
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.
204 CANTON RD, Cumming, GA 30040
Open in Google Maps ↗

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 MULTIPLE 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 11D0912305

Lakeside Pediatric LLC · Cumming, GA
Active · expires Feb 28, 2028
CLIA Number11D0912305
Laboratory TypePhysician Office
Certificate Effective DateFebruary 28, 2026
Certificate Expiration DateFebruary 28, 2028
Laboratory DirectorBob B. Bagheri MD
Laboratory Phone(770) 886-5437
Laboratory LocationLakeside Pediatric LLC204 Canton Highway, Cumming, GA 30040
CLIA data matches this NPI record on: 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.

MR. SHAYAN BAGHERI PA-C
Physician Assistant
204 CANTON RD
CUMMING, GA 30040
Forsyth County (770) 886-5437
DENISE S VAZ C-PNP
Nurse Practitioner (Pediatrics)
204 CANTON RD
CUMMING, GA 30040
Forsyth County (770) 886-5437
BOB B BAGHERI M.D.
Pediatrics
204 CANTON RD
CUMMING, GA 30040
Forsyth County (770) 886-5437
DR. KAREM VIVIAN MENEZES M.D.
Pediatrics
204 CANTON RD
CUMMING, GA 30040
Forsyth County (770) 886-5437

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 Lakeside Pediatrics, LLC's NPI number?

The NPI number for Lakeside Pediatrics, LLC is 1326317520. It was assigned to this organization in the NPPES registry on December 19, 2011.

Where is Lakeside Pediatrics, LLC located?

Lakeside Pediatrics, LLC is located at 204 Canton Rd, Cumming, GA 30040. The listed phone number is (770) 886-5437.

What is Lakeside Pediatrics, LLC's specialty?

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

Does Lakeside Pediatrics, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D0912305) is associated with this NPI, valid through February 28, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lakeside Pediatrics, LLC was last updated on December 19, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.