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THE PEDIATRIC OFFICE, LLC
NPI 1629025432
Pediatrics - Adolescent Medicine in Evans, GA

Active since May 27, 2006
4321 UNIVERSITY PKWY, SUITE 104, EVANS, GA 30809(706) 854-2600(706) 854-2601 Get Directions Write a Review

NPPES record last updated: November 5, 2008. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About The Pediatric Office, Llc NPPES

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

THE PEDIATRIC OFFICE, LLC (NPI 1629025432) is a healthcare organization registered as an adolescent medicine in Evans, Georgia and active in the NPI registry since May 2006. The organization lists Keelyn Clark Cunningham, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1629025432
Entity TypeOrganization
Primary Taxonomy2080A0000X
Legal Business NameTHE PEDIATRIC OFFICE, LLC
Location Address4321 UNIVERSITY PKWY, SUITE 104Evans, GA 30809-3058
Mailing Address4321 University Pkwy, Suite 104Evans, GA 30809-3058 · (706) 854-2600 · Fax (706) 854-2601
Phone(706) 854-2600
Fax(706) 854-2601
Organization SubpartNo
Authorized OfficialKeelyn Clark CunninghamOffice Manager · (706) 854-2600
Enumeration DateMay 27, 2006
Last NPPES UpdateNovember 5, 2008
✔ NPI 1629025432 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080A0000X
Definition
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
4321 UNIVERSITY PKWY, Evans, GA 30809
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Other Identifiers 1

Medicaid300035984AGA

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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

The Pediatric Office, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to The Pediatric Office, LLC, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Margaret Renew, MD
Pediatric Medicine
NPI 1699759688
4321 UNIVERSITY PKWY SUITE 104
Evans, GA 30809
(706) 854-2600
✔ PECOSSame address
Deepa Jagdale, M.D.
Pediatric Medicine
NPI 1447412184
699 FURYS FERRY RD
Martinez, GA 30907
(706) 901-7337
✔ PECOS2.6 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 The Pediatric Office, LLC's NPI number?

The NPI number for The Pediatric Office, LLC is 1629025432. It was assigned to this organization in the NPPES registry on May 27, 2006.

Where is The Pediatric Office, LLC located?

The Pediatric Office, LLC is located at 4321 University Pkwy Suite 104, Evans, GA 30809. The listed phone number is (706) 854-2600.

What is The Pediatric Office, LLC's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

Is The Pediatric Office, LLC enrolled in Medicare?

Yes. The Pediatric Office, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through The Pediatric Office, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Pediatric Medicine, reassign their Medicare billing to The Pediatric Office, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for The Pediatric Office, LLC was last updated on November 5, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.