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SOUTHERN CRESCENT PEDIATRICS PC
NPI 1437145950
Pediatrics in Ellenwood, GA

Active since September 20, 2005CLIA 11D0703348 · Certificate of Compliance
191 FAIRVIEW RD, ELLENWOOD, GA 30294(770) 389-5500(770) 389-4959 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Southern Crescent Pediatrics Pc NPPES

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

SOUTHERN CRESCENT PEDIATRICS PC (NPI 1437145950) is a healthcare organization registered as a pediatrics in Ellenwood, Georgia and active in the NPI registry since September 2005. The organization holds a CLIA Certificate of Compliance certificate valid through November 11, 2027 and lists Juan Jose Sherwood, President, as its authorized official.

NPPES Registry Identity

NPI1437145950
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameSOUTHERN CRESCENT PEDIATRICS PC
Location Address191 FAIRVIEW RDEllenwood, GA 30294-2722
Mailing Address150 Medical Blvd, Ste BStockbridge, GA 30281-5053 · (770) 389-9944 · Fax (770) 389-1973
Phone(770) 389-5500
Fax(770) 389-4959
Organization SubpartNo
Authorized OfficialJuan Jose SherwoodPresident · (770) 389-9944
Enumeration DateSeptember 20, 2005
Last NPPES UpdateAugust 22, 2020
✔ NPI 1437145950 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.
191 FAIRVIEW RD, Ellenwood, GA 30294
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Other Identifiers 3

Other7802Kaiser Pos
Other0526682Aetna Select/us Healthc
Other276714Bcbs

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 Compliance 11D0703348

Southern Crescent Pediatrics PC · Stockbridge, GA
Active · expires Nov 11, 2027
CLIA Number11D0703348
Laboratory TypePhysician Office
Certificate Effective DateNovember 12, 2025
Certificate Expiration DateNovember 11, 2027
Laboratory DirectorLankala Reddy MD
Laboratory Phone(770) 389-9944
Laboratory LocationSouthern Crescent Pediatrics PC150 Medical Blvd Suite B, Stockbridge, GA 30281
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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 Southern Crescent Pediatrics PC's NPI number?

The NPI number for Southern Crescent Pediatrics PC is 1437145950. It was assigned to this organization in the NPPES registry on September 20, 2005.

Where is Southern Crescent Pediatrics PC located?

Southern Crescent Pediatrics PC is located at 191 Fairview Rd, Ellenwood, GA 30294. The listed phone number is (770) 389-5500.

What is Southern Crescent Pediatrics PC's specialty?

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

Does Southern Crescent Pediatrics PC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 11D0703348) is associated with this NPI, valid through November 11, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Southern Crescent Pediatrics PC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.