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COURTNEY YUNG WIDJAJA M.D.
NPI 1356904379
Pediatrics in Lawrenceville, GA

Active since April 16, 2019PECOS Enrolled
595 HURRICANE SHOALS ROAD NW, SUITE 300, LAWRENCEVILLE, GA 30046(770) 995-0823(770) 995-7018 Get Directions Write a Review

NPPES record last updated: September 23, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Sep 23, 2022, Aug 10, 2022, Apr 16, 2019 (3 updates tracked since 2019).

About Courtney Yung Widjaja M.d. NPPES

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

COURTNEY YUNG WIDJAJA M.D. (NPI 1356904379) is an individual pediatrics provider in Lawrenceville, Georgia, licensed in Georgia (92344) and active in the NPI registry since April 2019. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1356904379
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameCOURTNEY YUNG WIDJAJACredential: M.D.
Location Address595 HURRICANE SHOALS ROAD NW, SUITE 300Lawrenceville, GA 30046
Mailing Address595 Hurricane Shoals Road Nw, Suite 300Lawrenceville, GA 30046 · (770) 995-0823 · Fax (770) 995-7018
Phone(770) 995-0823
Fax(770) 995-7018
Sole ProprietorNo
Enumeration DateApril 16, 2019
Last NPPES UpdateSeptember 23, 20223 updates tracked since enumeration
NPPES CertifiedSeptember 23, 2022
✔ NPI 1356904379 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Licenses✔ Licensed in GA · 92344✔ Licensed in GA · 10825
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.

595 HURRICANE SHOALS ROAD NW, Lawrenceville, GA 30046
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Courtney Yung Widjaja M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30046 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$88.06 typical visit price
range $56.84 – $172.43
Typical copayment $22.01 (range $14.21 – $43.10)
Most-billed visit code 99203
Established Patient
$100.20 typical visit price
range $18.22 – $140.40
Typical copayment $25.05 (range $4.55 – $35.10)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

SCOTT DARBY M.D.
Pediatrics
595 HURRICANE SHOALS ROAD NW, SUITE 300
LAWRENCEVILLE, GA 30046
Gwinnett County (770) 995-0823
KEYANA RENEE WASHINGTON M.D.
Pediatrics
595 HURRICANE SHOALS ROAD NW, SUITE 300
LAWRENCEVILLE, GA 30046
Gwinnett County (770) 995-0823
MONIQUE WELSH-EVANS M.D.
Pediatrics (Adolescent Medicine)
595 HURRICANE SHOALS ROAD NW, SUITE 300
LAWRENCEVILLE, GA 30046
Gwinnett County (770) 995-0823
MRS. LAUREN ASHLEY GARMON C.P.N.P.
Nurse Practitioner (Pediatrics)
595 HURRICANE SHOALS ROAD NW, SUITE 300
LAWRENCEVILLE, GA 30046
Gwinnett County (770) 995-0823
MR. HOMARE MAX KUBAGAWA M.D.
Pediatrics
595 HURRICANE SHOALS ROAD NW, SUITE300
LAWRENCEVILLE, GA 30046
Gwinnett County (770) 995-0823
SUSAN MARIE SMILEY MD
Pediatrics
595 HURRICANE SHOALS ROAD NW, SUITE 300
LAWRENCEVILLE, GA 30046
Gwinnett County (770) 995-0823
ASHLEY Z STOLLE MD
Pediatrics
595 HURRICANE SHOALS ROAD NW, SUITE 300
LAWRENCEVILLE, GA 30046
Gwinnett County (770) 995-0823
DR. SUZANNE MOLOCK MD
Pediatrics
595 HURRICANE SHOALS ROAD NW, SUITE 300
LAWRENCEVILLE, GA 30046
Gwinnett County (770) 995-0823

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 Courtney Widjaja's NPI number?

The NPI number for Courtney Widjaja is 1356904379. It was assigned to this individual provider in the NPPES registry on April 16, 2019.

Where is Courtney Widjaja located?

Courtney Widjaja practices at 595 Hurricane Shoals Road NW Suite 300, Lawrenceville, GA 30046. The listed phone number is (770) 995-0823.

What is Courtney Widjaja's specialty?

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

Is Courtney Widjaja enrolled in Medicare?

Yes. Courtney Widjaja is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Courtney Widjaja was last updated on September 23, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.